Revised Rate List

Annexure-I
Revised Rate List under the West Bengal Health Scheme, 2008
(Notification No. 796-F (MED) dated 31-01-2011)
01 – PROCEDURES
Maximum
Approved
NAME OF TREATMENT Rate (INR)
CODE PROCEDURE (Rupees)
001 General
01001001 Consultation by Medical
Officer (OPD) 150/-
01001002 SpecialistsConsultation(OPD)by 200/-
Visit/ Revisit/ Consultation
(Maximumby Specialiststwo visits(Indoor)per
01001003 Consultationday admissible)by Super- 200/-
01001004 Visit/SpecialistsRevisit/ Consultation(OPD) 250/-
by Super-Specialists(Indoor)
(Maximum two visits per
01001005 day admissible) 250/-
01001006 Pre-operativeConsultationAnaesthetic 200/-
01001007 ParamedicalSpecial NursingConsultationCharge 75/-
01001008 (per shift of 12 hrs.) 150/-
01001009 Aya/(perAttendantshift of 12Chargehrs.) 75/-
01001010 Delayed primary suture 1700/-
01001011 SuturingDressingswithoutLargelocal 160/-
01001012 Suturinganesthesiaof wounds with 400/-
010010130100101401001015 RemovalDebridementlocalofanesthesiaBenignof woundsTumor 1200/-1100/-500/-
01001016 AspirationTherapeuticPlural Effusion - 1000/-
Abdominal Aspiration -
01001017 Therapeutic 1300/-
Removal of F.B.
0100101801001019 Bone MarrowSuperficialAspiration 1200/-1500/-
01001020 Joints Aspiration 1500/-
01001021 Strapping 100/-
0100102201001023 RemovalVenesectionof Stitches 300/-60/-
01001024 Phimosis Under LA 1500/-
nnexure-I
-01-2011)
Maximum
Approved
01001025 Lumbar puncture 700/-
01001026 Sternal puncture 1500/-
01001027 Injection for Haemorrhoids 1000/-
Injection for Varicose
01001028 Veins 1300/-
01001029 Catheterisation 120/-
01001030 Dilatation of Urethra 1100/-
01001031 Incision & Drainage 600/-
01001032 Intercostal Drainage 1500/-
01001033 RemovalPeritonealof softdialysistissue or 1800/-
01001034 regionalgeneral anaesthesiablock under 2400/-
01001035 SecondaryDressingsutureSmall of 100/-
01001036002 woundsSkin 1200/-
01002001 Excision of Moles 600/-
01002002 Excision of Warts 600/-
01002003 Excisioncontagiosumof Molluscum 600/-
01002004 Excision of Veneral Warts 600/-
01002005 I/DExcisionInjectionofKeloidCornsof 550/-
01002006 ChemicalAcneCautery (per 300/-
01002007 Excisionsittings)of Sebaceous 120/-
01002008 ExcisionCystsof Superficial 1700/-
01002009 Liipoma 2400/-
01002010003 Excision ofE.N.T.Dermoid Cysts 2450/-
01003001 sessionRemovalSpeechofof30-40therapyforeignminutesperbody 200/-
From Nose/ Ear/ Throat
01003002 (Day care package) 1500/-
01003003 Swallowing Therapy 250/-

01003004 Syringing 300/-
01003005 PolypPeritonsillarremovalabscessunder LA 800/-
01003006 TinnitusdrainageRetrainingunder LA 1600/-
01003007 Therapy 250/-
1
CODE
01003008
01003009
01003010
01003011
01003012
01003013
01003014
01003015
01003016
01003017
01003018
01003019
01003020
01003021010030220100302301003024
0100302501003026
01003027
0100302801003029
0100303001003031
01003032
01003033
01003034
01003035
01003036
01003037
01003038
01003039
01003040
01003041
01003042
01003043
01003044
01003045
01003046
Annexure-I

Maximum
Approved
PROCEDURE (Rupees)
Myringoplasty 10700/-
Staepedectomy 12000/-
Myringotomy with
EndoscopicGrommet Removalinsertion of 6000/-
Fish Bone 1000/-
Tympanotomy 8000/-
Paracentesis 4300/-
Tympanoplasty 14000/-
Mastoidectomy 15600/-
Otoplasty 16500/-
Labyrinthectomy 15600/-
Skull Base surgery 50000/-
Facial Nerve
Decompression 20000/-
Septoplasty 10200/-
SubmucousFractureRhinoplastySepto-rhinoplastycosmetic)ReductionResection(non- 12000/-15000/-10800/-9000/-
IntraTurbinectomyNasal Diathermy 9600/-6000/-
Endoscopic DCR 13000/-
EndoscopicSeptal Perf.SurgeryRepair 15000/-15000/-
LateralAntrumRhinotomyPuncture 3000/-1350/-
Cranio-facial resection 28000/-
Ethamoidectomy 17600/-
Caldwell Luc Surgery 12000/-
Angiofibroma Excision 18000/-
Endoscopic
Hypophysectomy 25000/-
Endoscopic Optic Nerve
Decompression 32000/-
Decompression of Orbit 30000/-
Ranula Excision 9600/-
Tongue Tie excision 8100/-
Sub Mandibular Duct
Lithotomy 9700/-
Adenoidectomy 8000/-
Palatopharyngoplasty 15100/-
Cleft Palate repair 16000/-
Pharyngoplasty 18000/-
Styloidectomy 11500/-
Maximum
Approved
01003047 Uvulo-palatoplasty 20000/-
01003048 Tympanomastoidectomy 15600/-
01003049 Dacunisation 7000/-
01003050 Tonsillectomy 11200/-
01003051 Adenotonsillectomy 13500/-
01003052 Synichiolysis 4200/-
01003053 SubmucosalNasal Mass DiathermyExcision- 4000/-
01003054 Simple 11200/-
Nasal Mass Excision-
01003055 Endoscopic Removal 13500/-
01003056 FESS 11200/-
01003057 Anterior Nasal Packing 4000/-
01003058 Post Nasal Packing 5000/-
01003059 Nasal Bone Reduction 6000/-
004 Opthalmology
01004001 ulcer/subconjuctivalinjectionCauterisationCauterisation- One eyeofof 200/-
01004002 Retrobularinjectionulcer/subconjuctivalInjection- Both eyes- One 300/-
01004003 Eye 200/-
01004004 RetrobularEyesInjection - Both 300/-
01004005 Syringing-ForofoneLacrimaleye Sac 200/-
Syringing of Lacrimal Sac
01004006 - For both eyes 300/-
01004007 Paracentesis 800/-
01004008 Foreign body removal 300/-
01004009 Refraction/Fundoscopy 90/-
01004010 Ortho-optic exercises 100/-
01004011 Plepoptic Exercises 100/-
Chalazion operation -One
01004012 Eye 800/-
Chalazion operation -
01004013 Both Eyes 1000/-
01004014 Dressing (Eye) 100/-
01004015 Clinical Photography 100/-
01004016 Pterygium 2200/-
01004017 Orbitotomy 9000/-
01004018 Ptosis correction. 6500/-
01004019 Ectropion Correction 3600/-
01004020 Xenon Arc Laser 700/-
2
CODE
01004021
01004022
01004023
01004024
0100402501004026
0100402701004028
01004029
01004030
01004031
01004032
01004033
01004034
0100403501004036
01004037
01004038
01004039
0100404001004041
01004042
01004043
01004044
01004045
01004046
01004047
01004048
Annexure-I

Maximum
Approved
PROCEDURE (Rupees)
D C R (Dacryo custo-
rhinostomy) 5700/-
ECCE/ICCE 6000/-
Epicanthus correction. 2100/-
Squint Correction (one
eye) 4000/-
SquintKeratoplastyCorrectioneyes) (both 14000/-6000/-
TrabeculotomyIridectomy 2400/-5700/-
ScleralGoniotomyBukling (Retinal 2400/-
Detachment Surgery) 14000/-
Syringing & Probing 1100/-
Vitrectomy 11000/-
Enucleation 4000/-
Eviseration 3800/-
CataractEntropionlenswithextra)correctionIOL(Cost of 7500/-3000/-
GlucomaFistulectomysurgery with 5700/-
Glucoma valves 5000/-
Caliculoplasty 3000/-
PtosisDacryocystectomysurgeryresectionwith LPS 3000/-7000/-
Ptosis surgery with Sling
surgery 7000/-
EctropionEctropionsurgery-surgery-onebothlid 3000/-
Cheek rotationlids flap for lid 4000/-
tumors 8000/-
Telecanthus correction 4000/-
Fracture orbital repair 9000/-
Lasik 18000/-
Maximum
Approved
TTT- Transpupillary
01004049 thermal therapy 4000/-
PTK- Phototherapeutic
01004050 keratectomy 9000/-
01004051 Iris cyst removal 1000/-

01004052 LidOrbitalAbscessAbscessdrainageincisionincisionand 3000/-
01004053 and drainage 4000/-
01004054 Cyclodiathermy 2000/-
01004055 Perforating injury repair 4000/-
PhacoFoldable+ IOL& Non-foldable(inclusive of
01004056 lens) Package 14500/-
YAG Laser Capsulotomy
01004057 per sitting 600/-
01004058 YAG LaserArgonsittingIridectomyLaser per 600/-
01004059 Trabeculoplasty(per sitting)(ALT) 1000/-
01004060 HVF 500/-
01004061 Cryopexy 1200/-
01004062 ICGICG-includingDouble includingMedicine 2000/-
01004063 Medicine 3600/-
01004064 Electrolysis (Per sitting) 150/-
01004065 CyclodiathermyCyclocryo/ 500/-
01004066 D.C.T. (OPD) 800/-
01004067 Silicone Oil (1000) 4000/-
01004068 Silicone Oil (C 5) 4000/-
01004069 Silicone Oil Removal 3500/-
01004070 Pneumo Retinopexy 2400/-
3
Annexure-I
Maximum
Approved
CODE PROCEDURE (Rupees) CODE
01004071 FGE/ FAE 1500/- 01004092
01004072 Indirect Laser 1000/- 01004093
01004073 Endo Laser 2400/- 01004094

01004074 SF 6 Gas 2400/- 01004095
01004075 C 3F 8 Gas 2400/- 01004096
0100407601procedurePhPFCLeye 15000/-2400/- 01005001005

procedurePhotodynamiccharges-Therapyboth 01005002
01004078 Photodynamic eyes
Therapy 25000/- 01005003
01004079 (single eye) 85000/- 01005004
Photodynamic Therapy
01004080 (both eyes) 100000/- 006
Intravitreal Avastin 01006001
01004081 (including single)cost of injection- 6000/- 01006002
Intravitreal Lucentis 01006003
(excluding cost of 01006004
01004082 injection-single) 4000/- 01006005
Intravitreal Macugen 01006006
(excluding cost of 01006007
01004083 injection-single) 4000/- 01006008
Intravitreal injections of 01006009
01004084 antibioticsmedicines(costextra)of 2000/- 01006010
Retinal Foreign Body 01006011
01004085 Removal 4000/- 01006012
007
01004086 PPV/ Victerectomy 6500/-
01007001
01004087 Endo Diathermy 1600/-
01007002
01004088 Belt Buckle 3200/-
01007003
01004089 IVTCA 800/- 01007004
01004090 Membrane Peeling 2400/- 01007005
01004091 Anterior Vitrectomy 5000/- 01007006

Scheme, 2008
01-2011)
Maximum
Approved
PROCEDURE (Rupees)
Lensectomy 7500/-
Orbitotomy (Multiple Wall) 16000/-
ERM (Epi Retinal
Membrane) 3600/-
Reti Blue 2400/-
Corneal Collagen Cross-
linking 15000/-
Biopsies including
HistopathologicalBiopsyLocal(Package)procedureAnaesthesiaunderreport 4000/-
BiopsyGeneralprocedureAnaesthesiaunder 6000/-
BiopsyEndoscopyprocedure under 8000/-
FNAC 3500/-
Strapping (including
Bandage & materials)
Strapping of Finger 200/-
Strapping of Toes 200/-
Strapping of Wrist 360/-
Strapping of Elbow 400/-
Strapping of Knee 400/-
Strapping of Ankle 400/-
Strapping of Chest 500/-
Strapping of Shoulder 450/-
Nasal bone fracture 450/-
Figure of 8 bandage 450/-
Colar and cuff sling 450/-
PhysiotheraphyBall bandage & 450/-
Traction
Ultrasonic therapy (per
sitting) 70/-
S.W. Diathermy (per
sitting) 90/-
Electrical stimulation
(therapeutic) (per sitting) 70/-
Infra red (per sitting) 90/-
U.V. Therapeutic(per sitting) dose 90/-
Electric vibrator (per
sitting) 90/-
4
Annexure-I
Maximum
Approved
Vibrator belt massage
01007007 (per sitting) 90/-
Intra Lumbar Traction
01007008 (per sitting) 90/-
Intermittent Cervical
01007009 traction (per sitting) 70/-
01007010 CervicalCombinedsitting)tractionLumbar(per& 70/-
01007011 Wax bath (per sitting) 50/-
01007012 Hot pack (per sitting) 70/-
Whirl pool bath (per
01007013 sitting) 90/-
Obesity Exercises (per
01007014 sitting) 60/-
Breathing Exercises &
Postural Drainage (per
01007015 sitting) 70/-
Cerebral Palsy – Massage
01007016 (per sitting) 90/-
Post – polio exercise (per
01007017 sitting) 60/-
Basic Gait Training (Per
01007018 Session) 80/-
01007019 Traction + IFT 150/-
01007020 Traction + Stimulation 100/-

01007021 Traction + SWD 100/-
01007022 Traction + SWD + IFT 200/-
01007023 Traction + US 140/-
01007024 Traction + US + IFT 200/-

Traction + US + IFT +
01007025 Exercises 260/-
Traction + US + IFT +
01007026 SWD 260/-
01007027 IFT + PWB 150/-
01007028 PWBExercise-+ KneeperJointsittingSpad 60/-

01007029 Fraction 100/-
nexure-I
Maximum
Approved
01007030 SWD + IFT 100/-
01007031 US + IFT 100/-
01007032 US + IFT + Stimulation 200/-

01007033 US + KneeFractionJoint + Spad 100/-
01007034 US + PWB 100/-
01007035 US + SW + Traction 200/-
01007036 US + Tens 100/-
01007037 US + Stimulation 100/-
01007038 Knee Joints Spad Fraction 100/-

Electronic Tilt Training-
01007039 Per Session 100/-
01007040 Interferential Therapy 100/-

Laser Treatment- Per
01007041 Session 150/-
Microwave Diathermy- Per
01007042 Session 150/-
Quadriceps Chair Training
01007043 (Per Session) 100/-
01007044 Tens 80/-
008 Dental
Extraction of tooth
01008001 including LA 120/-
Complicated Ext. per
01008002 Tooth including LA 250/-
01008003 Flap Operation per Tooth 500/-
01008004 Gingivectomy per tooth 300/-
01008005 Cyst under LA (small) 300/-
01008006 Cyst under LA (large) 500/-
Impacted Molar including
01008007 LA 800/-
01008008 Apisectomy including LA 1000/-
Fracture wiring including
01008009 ReductionLA & 80/-
01008010 immobilisationMaxilla underof fracture-LA 1400/-
5
Annexure-I
Maximum
Approved
Reduction &
immobilisation of fracture-
01008011 Mandible under LA 3000/-
Splints/ Circum
mandibular wiring under
01008012 GA 2000/-
Internal wire fixation/ plate
01008013 fixation of MaxillaLA under 4000/-
01008014 Internalfixationwireof GAMaxillafixation/underplate 6000/-
Internalfixation ofwireMandiblefixation/underplate
01008015 Cyst & TumourLA/GAof Maxilla/ 6000/-
mandible by enucleation/
01008016 excision (package) 2000/-
TM joint ankylosis- under
01008017 GA (package) 11000/-
Hemi-mandibulectomy
01008018 with graft (package) 7000/-
Hemi-mandibulectomy
01008019 without graft (package) 4000/-
Segmental-
mandibulectomy with graft
01008020 (package) 6000/-
Segmental-
mandibulectomy without
01008021 graft (package) 2000/-
01008022 Maxillectomy-graft (package)partial with 5000/-
Maxillectomy- partial
01008023 without graft (package) 4000/-
Maxillo-facial prosthesis
(sal/ auricular/ orbital/
01008024 facial lost part) (package) 5000/-
Alvelolectomy,
01008025 Frenectomy per Quadrant 1150/-
01008026 Alvelolectomy (minor) 380/-
Amalgam Filling/tooth
01008027 (compound) 450/-
Amalgam Filling/tooth
01008028 (regular) 380/-
01008029 Apicoectomy Molar Tooth 2250/-

01008030 Arch Bar Removal 380/-
0100803101CastBite Plate/Rpd (perRetainersTooth) 1150/-380/-
Davis Crown/ radicular
01008033 Screw supported 1900/-
nexure-I
Maximum
Approved
01008034 De Sensitising per sitting 200/-
Dento Alveolar Fracture
01008035 Reduction & Splinting/l.a. 1500/-
Denture Repair
01008036 (category1) 230/-
Dialation of Whartons
01008037 Duct under L.A. 1150/-
01008038 Direct/Cappingindirect Pulp 230/-
01008039 Drain.EnucleationAbsce.of Dento(ex.ofOral)AlveolarCyst of 950/-
01008040 Fibre PostOralBasedCavityPost & 2000/-
01008041 Core 1900/-
Floride Application (per
01008042 sitting) 400/-
Extraction of Impacted
01008043 Tooth By Operation 400/-
Extraction of MISP Tooth

01008044 by Operation (Open Meth) 1150/-
GTR (Guided Tissue
01008045 Regeneration) 1900/-
Gingivectomy per
01008046 Quadrant 750/-
01008047 Glass Ionomer Filling 400/-

01008048 Glass Ionomes Filling 450/-
01008049 Interdental Wiring 1150/-
Intra Articular Inj. of
01008050 Steroids in TMJ 900/-
01008051 Jacket Crown Acrylic 1500/-

Minor Dento-alveolar
Tracture Reduction &
01008052 Splinting/la 950/-
Post Core/ tooth (cast
Post) lab Metal Chgs.
01008053 Extra 1150/-
Post Core/ tooth (pin
01008054 Retained.comp.core) 750/-
Post Core/ tooth
Screw/pin Retain.
01008055 Preformedamalgm.Carbonate 550/-
01008056 Jacket Crown 750/-
6
Annexure-I
Maximum
Approved
01008057 Preformed Steel Crown 1150/-
01008058 Pulpotomy 750/-

Reduction of Dislocation
0100805901Reimplantationof TmjTooth)(Under LA.)(per 3400/-1400/-
01008061 Removal(1stPartialTooth)Denture 400/-
Removable Partial
01008062 Denture (Additional Tooth) 230/-
Removable Partial
Denture per Tooth (Palatal
01008063 Bar) 750/-
0100806401TissueRepairRepairTissueLacerationofofLacerationFacialFacial(minor)SoftSoft 1150/-750/-
01008066 Root(UptoCanal4 Sitting)Treatment 1150/-
Root Canal Treatment
01008067 (Extra Sitting) 400/-
Root Canal Treatment
with Filling and Crown
(package) (Lab. Charges
01008068 extra) 3600/-
01008069 Scaling per Sitting 400/-
Sialolithotomy for Small
01008070 Stones 115/-
Surgical Extraction or
Surgical Removal of
01008071 Impact (package) 1150/-
Surgical Removal of Benin
Reoplasm of Oral
01008072 (package) 1500/-
Surgical Removal of Soft
01008073 Tissue Lesion (package) 1150/-
Surgical Removal of
Impact Mesiod.tuber
01008074 (package) 1150/-
ITU/CCU CHARGES
009 (Special Care Cases)
ICU/ITU/CCU/NICU/PICUECG/SPO(including:-/NIBP/IBPOxygen;
monitoring; 1:22 Nursing ë
GNM Nursing; Round the
01009001 spot);Clock Diet;DoctorSyringe(ResidentPump)on 2400/-
nexure-I
Maximum
Approved
(includingVentilatoraccessories)charge
01009002 per day 1000/-
Pneupack Ventilator in
01009003 Nursery (per day) 800/-
01009004 HighDownDefinition(includingUnit/Oxygen)Step 1500/-
01009005 ExchangeO.T. ChargesTransfusionfor 1200/-
01009006 Exchange transfusion 400/-
010 Oxygen Charges
Private/ Semi-private/
01010001 General Ward per hour 60/-
011 Burn Cases
01011001 dressingDressinguptomedicines)30%materials(excludingBurns 1stand 700/-
Subsequentupto 30% DressingBurns
(excluding dressing
01011002 materials and medicines) 700/-
30% to 50% Burns 1st
Dressing (excluding
dressing materials and
01011003 medicines) 700/-
30% to 50% Burns
Subsequent Dressing
(excluding dressing
Extensive Burn above
50% Frist Dressing
(excluding dressing
Extensive Burn above
50% Subsequent dressing
(excluding dressing
Burn Unit Bed (including
01011007 Oxygen) 1500/-
Obstetric &
012 Gynaecology Cases
01012001 NormalEpisiotomydelivery& P.orrepairwith 12000/-
01012002 Low Forceps 12000/-
01012003 Low midcavity forceps 14000/-
01012004 Cesarean Section 20000/-
01012005 Cesarean Hysterectomy 22000/-
7
Annexure-I
Maximum
Approved
Rupture Uterus- closure &
01012006 repair with Tubal Ligation 22000/-
Perforation of Uterus after
D/E Laparotomy &
01012007 Closure 18000/-
Laparotomy-peritonitis
01012008 Lavage and Drainage 16000/-
Laparotomy-failed
01012009 laparoscopy to explore 6100/-
01012010 Salphingectomy 14000/-
01012011 Salphingo-Oophorectomy 18000/-
01012012 Ovarean Cystectomy 18000/-
01012013 Oopherctomy 15000/-
Broad Ligment
01012014 Haemotoma Drainage 12000/-
Exploration of perineal
Haematoma & Resuturing
01012015 of Episiotomy 12000/-
Exploration of abdominal
Haematoma (after
01012016 laparotomy + LUCS) 12000/-
Internal podalic version
01012017 and extraction 12000/-
01012018 ManualPlacentaRemoval of 3700/-
MRP3rd stagefor outsideComplicationdelivery
01012019 Examinationetc under 4900/-
010120200101 Burst-abdomenanaesthesiaRepair 2500/-3300/-
01012022 GapingSecondaryParenealSuturingWound 2500/-
01012023 GapingSecondaryabdominalSuturingwound 3700/-
01012024 Completerepairperineal tear- 2500/-
01012025 Explorationrepairof PPH-tear 4200/-
01012026 Destructive Operation 12000/-
Suction evacuation
vesicular mole, Missed
01012027 abortion D/E 5900/-
Colpotomy-drainage P/V
01012028 needling EUA 4200/-
nexure-I
ealth Scheme, 2008
Maximum
Approved
Repair of post-coital tear,
01012029 perineal injury 4200/-
Excision of urethral
01012030 caruncle 4000/-
01012031 Laparoscopy (Gynae) 6100/-
Shirodhkar, Mc. Donalds
01012032 stich 3700/-
01012033 Laparotomy 20000/-
01012034 Abdominal Hysterectomy 22000/-

01012035 Vaginal Hysterectomy 22000/-
01012036 Myomectomy 22000/-
01012037 Vaginoplasty 22000/-

Vulvectomy
01012038 (Simple/Radical) 25000/-
01012039 RVF Repair 25000/-
01012040 Other Major Operations 25000/-
01012041 Manchester Operations 20000/-

01012042 Perineorrhaphy 14700/-
01012043 Colporraphy 14400/-
01012044 Modified Gilliam 16900/-
01012045 Shirodkar’s Operation 10200/-
01012046 Diagnostic Curettage 2700/-
01012047 Fractional Curettage 3400/-
01012048 D & C and Cervical Biopsy 3400/-
01012049 Polypectomy 3600/-
01012050 Other-Minor Operation 3600/-

Excision Vaginal
01012051 Cyst/Burtholin Cyst 3900/-
8
Annexure-I
Maximum
Approved
01012052 Excision Vaginal Septum 5900/-
01012053 Laparoscopy Diagnostic 6000/-

01012054 Laparoscopy Sterilisation 7300/-
01012055 Laparoscopy Operative 12000/-
01012056 Laparoscopy LAVH 25000/-
01012057 Drilling of Ovary 10800/-
01012058 Adhesiolysis 17400/-
Management of Ectopic
01012059 pregnancy 20000/-
01012060 Hysteroscopy TCRE 11500/-

Hysteroscopy Removal of
01012061 IUCD 5500/-
Hysteroscopy Removal of
01012062 Septum 11500/-
01012063 Hysteroscopy Diagnostic 7300/-

01012064 Werthimasfor CancerHystrectomycervix 30000/-
01012065 Sterilisation Post Pertum 4700/-
01012066 Sterilisation Intravaginal 6000/-
01012067 Abortion- D & C 3900/-
01012068 Abortion- Evacuation 4200/-
01012069 MTP- 1st Trimester 3200/-
01012070 MTP - 2nd Trimester 4800/-
01012071 Extended Hysterectomy 28000/-
013 General Surgery
01013001 Drainage of Abscess 2000/-
01013002 AspirationDressingofundercold AbscessG.A. 2400/-
0101300301Aspirationof Lymphnodeof Empyema 2400/-3100/-
nexure-I
Maximum
Approved
Aspiration of Liver
01013005 Abscess 3000/-
Open Drainage of Liver
01013006 DrainageAbscessof Pelvic 10000/-
01013007 DrainageAbscessof Ischiorectal 10000/-
01013008 DrainageAbscessof 8000/-
01013009 SubdiaphragmaticAbscess 14000/-
01013010 PerinephericOpen DrainageAbscessof 14000/-
01013011 DrainageAbscessof Perigastric 12000/-
Drainage of Perotid
01013012 Abscess 8000/-
Drainage of
01013013 Retropharyngeal Abscess 8000/-
Open Drainage of Psoas
01013014 Abscess 8000/-
Open Drainage of
01013015 Perivertebral Abscess 10000/-
Fissurectomy/
Haemorroidectomy/
01013016 Haemorroidectomy/CorrectionCorrection ofof PilesPiles 16000/-
01013017 (costwith ofStaplerGun extra)Gun 16000/-
01013018 ExcisionNeurofibromaof Superficial 2800/-
01013019 Varicose Veins 25000/-
01013020 Excision of Carbuncle 4000/-
014 Injury OfTissuesSuperficial Soft
015 Interestical (Implant)
01015001 Head & Neck 9700/-
01015002 Breast 9600/-
01015003 Soft Tissue Sarcome 12000/-
016 GASTROENTROLOGY
01016001 Capsule Endoscopy 30000/-
9
Annexure-I
Maximum
Approved
Complete Double Baloon
01016002 Enteroscopy 18000/- 01016025
Complete Small Bowel
01016003 Evaluation 30000/- 01016026
Argan Plasma Coa
01016004 (Major) 5000/- 01016027
Argan Plasma Coa
01016005 (Major) (BS) 6500/- 01016028
Argan Plasma Coa
01016006 (Minor) 2200/- 01016029
Argan Plasma Coa
01016007 (Minor) (BS) 3000/- 01016030
01016008 Band Ligation 3500/- 01016031
01016009 Band Ligation (BS) 5500/- 01016032
01016010 Biliary Brushing 1000/- 01016033
01016011 Biliary Brushing (BS) 1600/- 01016034
01016012 Biliary Pancreatic (M) 16000/- 01016035
01016013 Biliary Pancreatic (M) (BS) 23000/- 01016036
01016014 Biliary Pancreatic (P) 13300/- 01016037
01016015 Biliary Pancreatic (P) (BS) 18000/- 01016038
01016016 Cre Ballon Dilatation (BS) 15000/- 01016039
01016017 Cre Balloon Dilatation 9000/- 01016040
01016018 Dilatation (Stricture) 3000/- 01016041
01016019 Dilatation (Stricture) (BS) 4200/- 01016042

01016020 EMG Charge (Large) 3500/- 01016043
01016021 EMG Charge (Small) 1500/- 01016044
01016022 Endoscopic Tube Place 3000/- 01016045
Endoscopic Tube Place
01016023 (BS) 4200/- 01016046
01016024 Oesophageal Transit 1200/- 01016047
Maximum
Approved
PROCEDURE (Rupees)
Gastrostomy (PEG) 7000/-
Gastrostomy (PEG) (BS) 11000/-
Glue Injection 4500/-
Glue Injection (BS) 7000/-
Hemosta by Glod Probe 7000/-
Hemostatic Clip 7000/-

Hemostatic Clip (BS) 10000/-
Hepatonorm 700/-
Injection Hemostasis 4000/-
Injection Hemostasis (BS) 6000/-
LGI Manometry 4000/-
LGI Manometry (BS) 6000/-
UGI Manometry 3200/-
UGI Manometry (BS) 4500/-
Nasobiliary Drainage 12000/-
Nasobiliary Drainage (BS) 18000/-
Nasojejunal Tube Plac 3000/-
Nasojejunal Tube Plac
(BS) 4200/-
Papilla Cannu Minor 6500/-
Papilla Cannu Minor (BS) 8200/-
Pappu Stnt Spingt (M) 12000/-
Pappu Stnt Spingt (M)
(BS) 17500/-
Polypectomy (Colonic) 3200/-
10
Annexure-I
Maximum
Approved
01016048 Polypectomy(BS)(Colonic) 4800/-
0101604901PolypectomyPolypectomy(BS)(Upper(Upper GI)GI) 4500/-3000/-
01016051 Pre Cutting 4500/-

01016052 Pre Cutting (BS) 7500/-
01016053 Pseudocyst Drainage 9000/-
01016054 Pseudocyst Drainage (BS) 16000/-
01016055 Sclerotherapy 3000/-
01016056 Sclerotherapy (BS) 3800/-

01016057 Small Bowel Enteroscp 14000/-
01016058 Sphincterotomy 10500/-
01016059 Sphincterotomy (BS) 16000/-
01016060 Stone Extraction 12000/-
01016061 Stone Extraction (BS) 17000/-
01016062 Gastric Emptying 2500/-
01016063 Mechanical Lithotripsy 25000/-
01016064 ERCP (Stenting) 10000/-
017 Head & Neck
01017001 Ear Lobe Repair one side 600/-
Excision of Pinna for
Growth (Squamous/Basal/
01017002 ExcisionInjuries)ofSkinPinnaOnlyfor 4500/-
Growth (Squamous/Basal/
Injuries) Skin and
01017003 Cartilage 6000/-
01017004 Partial AmputationPinna of 6000/-
01017005 Total Amputation of Pinna 7500/-
nexure-I
Maximum
Approved
01017006 ExcisionTotalAuditoryAmputationofMeatusExternal& 10250/-
01017007 ExcisionExcisionHygromaofofMinorCysticCystic 5500/-
01017008 Hygroma Major 8000/-
01017009 HygromaExcision Extensiveof Cystic 12300/-
01017010 ExcisionExcisionof Branchialof BranchialCyst 11000/-
01017011 ExcisionSinusof Pharyngeal 11000/-
01017012 MandibulectomyDiverticulum 12200/-
01017013 25000/-
01017014 Operation for Cervical Rib 30000/-
01017015 Pharyngectomy 35000/-
01017016 Stenosis Excision 17000/-
01017017 Commando Operation 27000/-
01017018 CervicalBlock DissectionLymph Nodesof 20300/-
01017019 PharyngectomyReconstruction& 40000/-
01017020 OperationLip - Wedgefor CarcinomaExcision 10000/-
01017021 OperationLip - Vermilionectomyfor Carcinoma 10000/-
LipOperation- WedgeforExcisionCarcinomaand
01017022 Vermilonectomy 12000/-
01017023 Estlander Operation 9700/-
01017024 Abbe Operation 12000/-
01017025 Cheek Advancement 10200/-
01017026 ExcisionExcisionofofthetheMandibleMaxilla - 23300/-
01017027 Segmental 18100/-
01017028 Hemimandibulectomy 27200/-
01017029 Partial Glossectomy 6100/-
01017030 Hemiglossectomy 13500-
01017031 TotalParotidectomyGlossectomy- 25000/-
01017032 Superficial 24000/-
11
Annexure-I
Maximum
Approved
Parotidectomy -
01017033 Conservative 19700/-
01017034 Parotidectomy - Radical 22000/-
01017035 Parotidectomy - Total 15000/-
01017036 Repair of Parotid Duct 20400/-

Removal of
Submandibular Salivary
01017037 gland 10000/-
01017038 Hemithyroidectomy 15000/-

01017039 Partial Thyroidectomy 16000/-
01017040 Subtotal(ToxicThyroidectomyGoitre) 22000/-
01017041 Total Thyroidectomy 23000/-
01017042 ResectionAdenomaEnucleation of 12500/-
01017043 Isthmectomy 12600/-
01017044 TotalBlockThyroidectomyDissection and 31400/-
01017045 ExcisionThyroidof Lingual 25650/-
01017046 ExcisionCyst/Fistulaof Thyroglossal 15000/-
01017047 ExcisionAdenoma/Carcinomaof Parathyroid 25600/-
01017048 Laryngectomy 37150/-
01017049 Laryngo Pharyngectomy 43500/-

01017050 Sinus & Fistula repair 14000/-
01017051 Lymph Node Excision 8000/-
0101705201HyoidGenioplastySuspension 12000/-12000/-
0101705401DirectPhonosurgeryLaryngoscopy 15400/-5400/-
01017056 Fibroptic Laryngoscopy 3000/-
01017057 Microlaryngeal Surgery 11000/-
01017058 Laryngofissure 17500/-
018 Head & Neck Cancer
01018001 Benign Tumour Excisions 11000/-
01018002 Temporal Bone resection 27600/-
01018003 Radical Neck Dissection 28500/-
nexure-I
Maximum
Approved
Carotid Body Excision
01018004 (cost of Graft extra) 36000/-
01018005 Total Laryngectomy 39050/-
Flap Reconstructive
01018006 Surgery 42800/-
Parapharyngeal Tumour
01018007 Excision 32000/-
01018008 Total Thyroidectomy 30000/-

019 Breast
01019001 Drainage of Abscess 7000/-
01019002 Excision of Lumps 10000/-
Local Mastectomy
01019003 (Simple) 13500/-
01019004 Radical(Formal Mastectomyor Modified) 28000/-
01019005 ExcisionFistulaof Mammary 16000/-
01019006 SegmentalBreastResection of 18300/-
01019007 Breast Cancerexcision)(Tumour 30000/-
020 CardioProceduresRespiratory
01020001 ThoracotomyTracheostomy(Penetrating 3700/-
01020002 IntercostalWounds)Drainage of 17500/-
01020003 Decorticationempyema 5400/-
01020004 (Pleurectomy) 37000/-
01020005 Thoracoplasty 37000/-
01020006 Pneumonectomy 37000/-
01020007 Lobectomy 37000/-
01020008 Segmental Resection 37000/-
01020009 HydatidVideo-assistedCyst- Removal 37000/-
01020010 LungthoracoscopicvolumeSurgeriesreductionlung 37000/-
surgery (Unilateral/
01020011 Bilateral) 37000/-
Thoracoscopic
01020012 Decortication 37000/-
Thoracoscopic
01020014 Thoracoscopic Lobectomy 37000/-
12
Annexure-I
Maximum
Approved
0102001501ThoracoscopicThoracoscopicCystResectionexcisionSegmental 37000/-37000/-
01020017 SympathectomyThoracoscopic 37000/-
Chest Wall Tumor
Excision with
01020018 Reconstruction 37000/-
Repair of Congenital
01020019 Chest Wall Defermities 37000/-
01020020 Multiple Lobectomy 37000/-

0102002101DecorticationDecorticationThoracoplastyThoracoplastyResection++Lung+ 37000/-37000/-
01020023 Open Lung Biopsy 18000/-
01020024 Medicistinoscopy(cervical) 15000/-
01020025 thoracoscopyVideo-assisted(VATS) 36960/-
0102002601SurgeryThoracotomyforLungDestroyedfor BPF 37000/-37000/-

01020028 SleeveLobectomyResection with 37000/-
Extrapleural
01020030 Tracheal Stenosis Surgery 37000/-

Repair of Tracheo
01020031 Innuminete Fistula 37000/-
01020032 TrachealTrachealResectionTumourfor 37000/-
01020033 Segmentectomy 37000/-
01020034 LungWedgeResectionResectionwith 37000/-
01020035 ParatrachealLungResectionResectionL. Nodewith 37000/-
01020036 Chest Wall Invasion 37000/-
nexure-I
CODE
01020037
01020038
01020039
01020040
01020041
021
01021001
01021002
01021003
01021004
01021005
01021006
01021007
01021008
01021009
01021010
01021011
01021012
NAME OF TREATMENT
PROCEDURE
DissectionSurgeryLung ResectionStationsforof LymphRecurrentwithNode
SurgeryPnemothoraxicfor Aspergillosis
(Lung Cavities)
Bronchotomy
Mediostonoscopy
Cardiac / Cardio
Thoracic Procedures
CoronaryCoronary(including(includingpost Profile)AngioplastyBypassBypassPre-SurgeryPre-SurgerySurgery-Surgery
CoronaryProfile)Balloon
(ExcludingAngioplastyCost of Stents)
Profile)(including(4 days’Pre-Surgerypackage)
Balloon angioplasty with
ValvotomyOpenSurgeryHeart(includingProceduresProfile) Pre-
(includingTotal CorrectionProfile)Pre-Surgeryof
Tetralogy of Fallot
(including Pre-Surgery
Profile)
RSUV Correction
Profile)
(includingTAPVCProfile)CorrectionPre-Surgery
Open ASD VSD (including
Pre-SurgeryOpen PulmonaryProfile)
ValvotomyOpenSurgeryAortic(includingProfile)ValvotomyPre-
(includingProfile)Pre-Surgery
Blalock Taussig Operation
Maximum
Approved
Rate (INR)
(Rupees)
37000/-
37000/-
37000/-
37000/-
15000/-
150000/-
150000/-
66000/-
90000/-
150000/-
150000/-
150000/-
150000/-
150000/-
150000/-
150000/-
72000/-
13
Annexure-I
Maximum
Approved
Profile)
Mitral Valvotomy 01021031
01021013 Mitral(Excluding(includingValveProfile)CostPre-SurgeryReplacementof
72000/- 01021032 Valve)
(including Pre-Surgery 01021033
01021014 Profile) 150000/- 01021034
0102101501AorticCost(ExcludingReplacement(includingPre-SurgeryofDoubleValveValves)Profile)CostPre-SurgeryReplacementValve(Exclu
160000/-150000/- 010210350102103
Thoraco-Abdomi Aorta 01021040
Replacement (including 01021041
01021017 Pre-Surgery Profile) 150000/-
Coarctation-Arota Repair 01021042
0102101801PericardiostomyPericardiectomyP150000/-54000/-720010210430102104
01021023 ImplantationPermanentPericard3900/- 010210490102105
Cost of Pacemaker) 01021052
01021024 (4 days’ package) 19400/-
Temporary Pacing Lead 01021053
Implantation (Including 01021054
use of Temporary 01021055
01021025 Pacemaker) 12600/-
01021026 Embolectomy 19800/-
Aneurysm- Resection & 01021056
0102102701GraftingThoracocentesisextra)(cost
96000/-2000/-
of Graft likeNote:-ValveCABGReplacementif done alongetc. willwithattractother Hear
01021029 Thorachostomy 5400/- 022
01021030 Exploratory Thorocotomy 37000/-
al Health Scheme, 2008
ated 31-01-2011)
NAME OF TREATMENT
PROCEDURE
Unifocalization with Shunt
Profile)
RemovalfromOesophagusofTracheaForeignorBody
Rib Resection & Drainage
Mediastinal Tumour
(Excluding(ExcludingASDPDAThymectomyEPDeviceDeviceDSACostCostSTUDYClosureClosureofof Device)Device)
3D RF Ablation
Mini EP Study
Coronary Angiography
(1 day’s package)
(Pacemaker(PacemakerPermanentPermanentIntraDirectiolImplantation(4HeartGunshot(Biventricular)days’ImplantationcoronaryFontentrans
FemoralIliacfemoraldays’Poplitialpackage)BypassBypass
Aorto Bifemoral Bypass
Carotid Subclavian
Bypass
PA Banding
BD Glen
Thoracic Aorta/ Arch
Replacement (including
Pre-Surgery Profile)
CABG.
Oesophagus
Maximum
Approved
Rate (INR)
(Rupees)
150000/-
6000/-
11500/-
35000/-
35000/-40000/-32000/-5400/-8400/-
40000/-
5000/-
11700/-
277000/-170000/-58000/-52000/-98000/-25000/-
30000/-75000/-75000/-
75000/-
75000/-
55000/-
55000/-
150000/-
14
Annexure-I
Maximum
Approved
Atresia of Oesophagus
and Tracheo
01022001 Oesophageal Fistula 29700/-
Operations for
01022002 OesophagusReplacementby Colonof 38000/-
01022003 CarcinomaOesophagectomyEasophagusfor 38000/-
Oesophageal Intubation
01022004 (Mausseau Barbin Tube) 15500/-
Achalasia Carida
01022005 Transthoracic 29700/-
01022006 AchalasiaAbdominalCarida 14600/-
01022007 OesophagusOesophagofor mid 1/3GastrectomyDilatationlesion of 38000/-
01022008 Colon-InterStricture- positionper visitor 1500/-
Replacement of
01022009 Oesophagus 38000/-
Oesophago Gastrectomy
– Lower Corringers
01022010 procedure 38000/-
01022011 InstallationEsophagealSurgeryofPerforationRyles Tube 38000/-
01022012 Esophagealin Ca EsophagusDirecticulum 5000/-
01022013023AbdomenSurgery 38000/-
01023001 Gastroscopy 1300/-
01023002 BiopsyGastric(Endoscopic)& Duodenal 1700/-
01023003 Pyleromyotomy 10000/-
01023004 Gastrostomy 12000/-
Simple Closure of
01023005 Perforated peptic Ulcer 15000/-
01023006 VagotomyGastro JejunostomyPyleroplasty / 30000/-
01023007 Duodenojejunostomy 25000/-
01023008 GastrectomyPartial/SubtotalCarcinomafor 30000/-
Partial/Subtotal
01023009 Gastrectomy for Ulcer 30000/-
nexure-I
Maximum
Approved
Operation for Bleeding
01023010 Peptic Ulcer 25000/-
Gastrojejunostomy &
01023011 Vagotomy 27000/-
01023012 GastrojejunalOperation forUlcer 25000/-
01023013 Total GastrectomyCancer for 35000/-
Highly Selective
01023014 Vagotomy 25000/-
Selective Vagotomy &
01023015 Drainage 25000/-
01023016 CongenitalHerniaDiaphragmatic 30000/-
01023017 HiatusHiatusAbdominalHerniaHernia RepairRepair 30000/-
01023018 Transthoracic 30000/-
01023019 Exploratory Laparotomy 12900/-
01023020 Epigastric Hernia Repair 15000/-
01023021 Umbilical Hernia Repair 15000/-
Ventral and Scar Hernia
01023022 Repair 18000/-
01023023 Herniorraphy-InguinalInguinalHerniaHerniaunilateral– 15000/-
01023024 Hernioplasty-unilateralwith mesh- 22000/-
01023025 FemoralRare HerniasHernia- RepairRepair 22000/-
01023026 (Spigalion,Lumbar, Obturator,Sciatic) 25000/-
01023027 SplenectomyTrauma - For 25000/-
Splenectomy - For
01023028 Hypersplenism 25000/-
01023029 Splenorenal Anastomosis 40000/-
01023030 Portocaval Anastomosis 40000/-
OesophagusDirect Operationfor Portalon
01023031 Hypertension 30000/-
01023032 MesentericocavalAnastomosis 35000/-
01023033 Warren Shunt 35000/-
01023034 Pancerato Duodenectomy 36000/-
15
Annexure-I
Maximum
Approved
By Pass Procedure for
Inoperable Carcinoma of
01023035 Pancreas 30000/-
Cystojejunostomy or
01023036 Cystogastrostomy 30000/-
0102303701CholecystectomyExplorationCholecystectomyof CBD& 18000/-22000/-
0102303901OperationRepair ofofforDuctCommonLiverHydatidBileCyst 20000/-25000/-
01023041 Cholecystostomy 14200/-
Hepatic Resections
01023042 (Lobectomy Hepatectomy) 28000/-
Operation on Adrenal
01023043 Glands - Bilateral 35000/-
Operation on Adrenal
Glands - Unilateral for
01023044 Tumour 20000/-
Appendicectomy for Acute
01023045 Appendicitis 20000/-
Appendicectomy for
01023046 Chronic Appendicitis 18000/-
01023047 AppendicularDrainageAbscess – 12000/-
0102304801MesentericPeritonioscopy/LaparoscopyCyst- Excision 18000/-5100/-
01023050 Jejunostomy 18000/-
01023051 Ileostomy 18000/-
0102305201StenosisCongenitalMuconiumof SmallAtresiaileusIntestine& 20000/-25000/-
Mal-rotation & Volvulus of
01023054 the Midgut 20000/-
Resection & Anastomosis
01023055 of Small Intestine 22000/-
Excision of Meckle’s
01023056 Deverticulum 22000/-
01023057 Duodenal Diverticulum 18000/-
Operation for Intestinal
01023058 Obstruction 25000/-
Operation for Intestinal
01023059 perforation 25000/-
nexure-I
NAME OF TREATMENT
CODE PROCEDURE
Benign Tumours of Small
01023060 Intestine
Excision of Small Intestine
01023061 Fistula
Operations for
01023062 HaemorrhageOperationsIntestinesofofthetheSmall
01023063 Operations(NobleIntestinalDuplicationIntestinesPlicationObstructionfor Recurrentof&theOther
Operations for the
01023064 Adhesions)
01023065 Ilieosigmoidostomy
01023066 Ilieotransverse Colostomy
01023067 Caecostomy
Loop Colostomy
01023068 Transverse Sigmoid
01023069 Terminal Colostomy
01023070 Closure of Colostomy
01023071 Right Hemi-Colectomy
01023072 Left Hemi-Colectomy
01023073 Total Colectomy
01023074 OperationsLargeforBowelVolvulus of
01023075 OperationsDiverticulitisfor Sigmoid
01023076 FissureFissurein Anoin -AnoDilatation-
01023077 Fissurectomy
01023078 RectalHaemorrhoidsOperationPolyp-Excision-Lordsof
01023079 procedure
Fistula in Ano - High
01023080 Fistulectomy
Fistula in Ano - Low
01023081 Fistulectomy
Imperforat Anus -
01023082 Colostomy
Imperforate Anus - Pull
01023083 Through Operation
Prolapse Rectum -
01023084 Theirch Wiring
Maximum
Approved
Rate (INR)
(Rupees)
25000/-
25000/-
25000/-
32000/-
28000/-
22000/-
22000/-
10000/-
20000/-
24000/-
24000/-
24000/-
24000/-
39000/-
25200/-
22000/-
6800/-
16000/-
8000/-
10000/-
20000/-
12000/-
16000/-
22000/-
15000/-
16
Annexure-I
Maximum
Approved
Prolapse Rectum -
01023085 Rectopexy 10000/-
Prolapse Rectum -
01023086 Grahams Operation 22000/-
Operations for
01023087 Hirschsprungs Disease 22000/-
01023088 Excision of Pilonidal Sinus 12300/-
01023089 AnteriorExcisionAbdomino-PerinealResectionof Rectumof 26700/-
01023090 rectum 26300/-
Pull Through Abdominal
01023091 Resection 22000/-
Operations for
01023092 Neuroblastoma 22000/-
01023093 Fistula/ Fistulotomy 12000/-
01023094 Hernioctomy 21000/-

Nephrology /
024 Genitourinary
01024001 Partial Nephrectomy 25000/-
01024002 Nephrolithotomy 25000/-
01024003 Pyelolithotomy 25000/-
01024004 HydronephrosisOperations for 25000/-
01024005 PerinephricOpen DrainageAbscessof 15000/-
01024006 OperationsCavernostomyfor Cyst of the 20400/-
01024007 Kidney 25000/-
01024008 Ureterolithotomy 20000/-
0102400901OperationsNephroureterectomyDoubleforUretersUreter for - 30000/-20000/-
Operations for Ureter -for
01024011 Ectopia of Single Ureter 27000/-
Operations for Vesico-
01024012 ureteric Reflux 28000/-
0102401301Uretero-ColicUreterostomyanastomosis- Cutaneous 20000/-20000/-
01024015 FormationConduitof an Ileal 22000/-
01024016 Ureteric Catheterisation 5000/-
01024017 DormiaCalculusExtraction of 6000/-
nexure-I
Maximum
Approved
Biopsy of Bladder
01024018 (Cystoscopic) 6000/-
Diathermy Destruction of
01024019 Bladder Neoplasm 15000/-
01024020 Litholapexy 15000/-
Operations for Injuries of
01024021 the Bladder 30000/-
01024022 SuprapubicVesicostomy)(Cystostomy/Drainage 12000/-
01024023 Total Cystectomy 35000/-
01024024 Diverticulectomy 32000/-
Open Resection of the
01024025 Bladder Neck 25000/-
Y-V Plasty of the Bladder
01024026 Neck 25000/-
01024027 Cystoplasty 28000/-
Operations for Extrophy of
01024028 the Bladder 40000/-
01024029 Repair of Ureterocoel 25000/-
01024030 Suprapubic Prostatectomy 25000/-
01024031 Retropubic Prostatectomy 25000/-
Transurethral Resection of
Prostate (TURP)/ TUR
01024032 IntravesicalBladder TumourBCG 25000/-
01024033 instillationOperationsextra)(Costfor Injuryof BCGto 500/-
01024034 Urethra 30000/-
01024035 Internal urethrotomy 15000/-
01024036 OperationUrethral Reconstructionfor Congenital 32000/-
01024037 IncontinenceValvesOperationsof Urethraof forUrine - 16000/-
01024038 Male 25000/-
Operations for
Incontinence of Urine -
01024039 Female 25000/-
01024040 CircumcisionParaphimosisReduction(underof 2450/-
01024041 General Anaesthesia) 6000/-
01024042 Meatotomy 3500/-
01024043 OperationsMeatoplastyfor 6800/-
01024044 Hypospadias - Chordee 15000/-
17
Annexure-I
Maximum
Approved
Correction
Operations for
HypospadiasStage or One- SecondStage
01024045 Repair 24000/-
01024046 Operations for Epispadias 22000/-
01024047 Partial AmputationPenis of the 14000/-
Total amputation of the
0102404801Orchidectomy-Penis Simple 14000/-20000/-
01024050 Orchidectomy- Radical 20000/-
Adreneclectomy
Unilateral/Bilateral for
01024051 Tumour/For Carcinoma 30000/-
Operations for Hydrocele -
01024052 Unilateral 8000/-
01024053 OperationsBilateralfor Hydrocele - 12000/-
Operation for Torsion of
01024054 Testis 15000/-
01024055 Vasovasostomy 18000/-
01024056 Operations for Varicocele 15000/-
Block Dissection of
01024057 Inguinal Nodes - One Side 25000/-
Block Dissection of
Inguinal Nodes - Both
01024058 ExcisionSidesof Filarial 32000/-
01024059 Scrotum 16000/-
Emergency Dialysis
01024060 Femoral Puncture 1200/-
Emergency Dialysis
0102406101SubclavianFistula/ShuntPuncture 1800/-8000/-
Dialysis Femoral
01024063 Catheterisation Bilateral 1500/-
Haemo Dialysis (All
01024064 Inclusive) 1500/-
01024065 DoubleClavianLumenCatheterSub 3000/-
Continuous Arterio Venus
Haemofiltration (CAVH)/
01024066 CAVD 17000/-
01024067 Subclavian Access 1850/-
01024068 Femoral Access 1750/-
nexure-I
Maximum
Approved
01024069 Plasma Exchange 2500/-
01024070 Donor Nephrectomy 50000/-
01024071 Renal Transplantation 250000/-
01024072 Ureteric Reimplant 4200/-
01024073 Lymphocoel 4300/-
01024074 Transplant Nephrectomy 35000/-
01024075 Nephrouretectomy 35000/-
01024076 VascularCAPDProsthetic(insertion Graft& 35000/-
01024077 removal) 8000/-
01024078 PCNLPCNL -–UnilateralBilateral/ 30000/-
01024079 PCNL-III 46000/-
01024080 Palomo’s Unilateral 7300/-
01024081 Palomo’s Bilateral 12600/-
01024082 Endoscopic Teflon Inject 5100/-
01024083 Testicular Biopsy 4350/-
01024084 Gil-Verner’sPyelolithotomyExtended 22000/-
Radical Nephrectomy
Complicated Tumour or
01024085 Adhesions 50000/-
Anderson Hynes
01024086 Pyeloroplasty 25000/-
Vasico Vaginal Fistula
01024087 Repair 30000/-
01024088 Radical Cystectomy 44000/-
01024089 Caeco Cystoplasty 26000/-
01024090 Nephrectomy Simple 25000/-
01024091 Nephrostomy 22000/-
01024092 Ureteric Reimplant 25000/-
01024093 Partial Cystectomy 28000/-
01024094 Epididymectomy 12000/-
01024095 TURP Cystolithotripsy 30000/-
01024096 Open Prostatectomy 28000/-
01024097 Closure of Urethral Fistula 28000/-
01024098 Orchidopexy - Unilateral 15000/-
01024099 OrchidopexyCystolithotomy- Bilateral- 20000/-
01024100 Suprapubic 15000/-
Endoscopic Removal of
01024101 Stone in Bladder 18000/-
Resection Bladder Neck
01024102 Endoscopic 18000/-
18
Annexure-I
Maximum
Approved
Ureteroscopic Removal-
01024103 with LASER 40000/-
Ureteroscopic Removal- 01024127
01024104 without LASER 18000/-
01024105 Urethroplasty 1st Stage 14000/- 01024128

01024106 Optical Urethrotomy 18000/- 01024129
01024107 Exploratory Scrototomy 10000/- 01024130
01024108 Perineal Urethrostomy 15000/- 01024131
Dilatation of Stricture 025
01024109 Urethra under G.A. 4000/- 01025001
Dilatation of Stricture
Urethra without 01025002
01024110 Anesthesia 2200/-
Retroperitoneoscopy 01025003
01024111 Nephrectomy 40000/- 01025004
01024112 Retroperitoneoscopypartial Nephrectomy
35000/- 01025005
01024113 Retroperitoneoscopicnephrolith 35000/- 01025006
01024114 Retroperitoneoscopicpyelolitho 35000/- 01025007
01024115 RetroperitoneoscopicHyderonephrosisoperation
35000/- for 01025008
01025009
01024116 surgeryRetroperitoneoscopicRetroperitoneoscopicfor
35000/- 01025010
Renal cyst
01024117 Retroperitoneoscopicureterolit 35000/- 01025011
01024118 LaproscopyNephroureteroectom35000/- 01025012
01024119 Laproscopicorchidopexyoperation22000/-
for 01025013
01024120 varicocele 20000/- 01025014
01024121 CystoscopicUrethraBasketing of12000/- 01025015
01024122 Lithotripsy/(Complete)ESWL 30000/- 01025016
01024123 Lithotripsy-1/Care)SMSL (Day 18000/- 01025017
Lithotripsy-2/3/ SMSL 01025018
01024124 Slow Efficiency(Day Care)Dialysis
23000/- 01025019
01024125 Prosthetic(SLED)Surgery for 4000/- 01025020
01024126 urinary incontinence 40000/-
l Health Scheme, 2008
ated 31-01-2011)
NAME OF TREATMENT
PROCEDURE
Hilioum Laser Prostrate
surgery/ Optical Internal
urethrotomy/ C
High Intensity Focus
Ultrasound (HIFU) Robotic
for Carcinoma
CRRT Procedure
TURP with LASER
Lithoclast (Day Care)
Plastic Surgery
Primary Suture of Wound
Injection of Keloids -
Ganglion
Injection of Keloids -
Haemangioma
Free Grafts - Wolfe Grafts
FreeFreeSmallGraftsGraftsArea-- LargeTheirech5% Area-
Free Grafts10%- Very Large
Skin FlapsArea 20%- Rotation
SkinFlapsFlaps -
Advancement Flaps
SkinLegSkinFlapsFlaps-FlapsFlap- Direct-Cross- Armcross Cross
Finger
Skin Flaps - Abdominal
Skin Flaps - Thoracic
SubcutaneousSkin Flaps - Pedicle Arm Etc.
SubcutaneousFlaps RaisingPedicle
SubcutaneousFlaps DelayPedicle
Flaps Transfer
ReductionCartilage Graftingof Facial
ReductionFractures ofof FacialNose
Fractures of Maxilla
Maximum
Approved
Rate (INR)
(Rupees)
30000/-
150000/-
11000/-
32000/-
16000/-
3200/-
2700/-
6100/-
18000/-
18500/-
30000/-
32400/-
28750/-
31650/-
35500/-
35500/-
35500/-
34400/-
35500/-
28500/-
27750/-
28500/-
29700/-
9000/-
13800/-
19
Annexure-I
Maximum
Approved
01025021 ReductionMandibleLet &SplintingofMaxillaFractures- Eyeof 27000/-
01025022 MandibleReductionNetal&ofMaxillaSplintsFractures- Castof 27000/-
ReductionMandibleof&FracturesMaxilla - of
0102502301InternalMandibleGummingWire&FixationSplintsMaxilla of 27000/-32000/-
0102502501CleftCleftSeverePalateLip Degree- repair.Repair 33800/-32400/-
01025027 PrimaryCleftBoneLip PalateGrafting of 34550/-

01025028 SecondaryCleft Lip DeformitySurgery for 32600/-
Secondary Surgery for

01025029 Cleft Palate 31350/-
01025030 ReconstructionReconstructionDefects - Minorofof EyelidEyelid 17550/-
01025031 Defects - Major 30000/-
Plastic Surgery of
Different Regions of the
01025032 PlasticEar Surgery- Minor of 10000/-
01025033 DifferentEarRegions- Major of the 20000/-
01025034 PlasticNoseSurgery- Minorof the 10000/-
Plastic Surgery of the
0102503501PlasticParalysisReanimation)NoseSurgery(Support- Majorfor Facialwith 32000/-20000/-
Pendulous Breast -
01025037 Mammoplasty 22550/-
Orthopaedic Surgery
026 Procedure
01026001 Applicationfor Upper &ofLowerP.O.PLimbsCasts 7500/-
nexure-I
Maximum
Approved
01026002 ApplicationCast ofBraceFunctional 7500/-
01026003 ApplicationApplicationTractionofofSkeletalSkin 1650/-
01026004 BandageTractions& Strappings for 4450/-
01026005 AspirationFractures& Intra Articular 1150/-
01026006 Injections 950/-
01026007 ApplicationCloseSpicesReduction& Jacketsof P.O.Pof 6000/-
01026008 Fractures of Limb & P.O.P 7500/-
01026009 OpenReductionReductionFracturesof Compound& Internal 10000/-
01026010 FixationfractureOpenofofReductionFingursLong Bones&ofToesof 18000/-
Upper / Lower Limb -
01026011 Nailing & External Fixation 28000/-
Open Reduction of
01026012 fractureUpperProcedures/ ofLowerLongLimbBones-AOof 27000/-
01026013 Tension Band Wirings 6000/-
01026014 ExcisionBoneof BoneGraftingTumours 18000/-

01026015 Excision-Superficialof Bone Tumours 28000/-
01026016 -Deep 40000/-
01026017 Excision of Ganglion 10000/-
01026018 OperationsSequestrectomyExcisionFracturesfororScaphoidother& 25000/-
Saucerizations -
01026019 Superficial 20000/-
Sequestrectomy &
01026020 Saucerizations -Deep 30000/-
Sequestrectomy &
01026021 SaucerizationsArthrotomy - 35000/-
20
Annexure-I
Maximum
Approved
01026022 S.P.NailingNeck Femurfor Fracture 35000/-
Multiple Pinning Fracture
01026023 Neck Femur 35000/-
Nail Plate Fixations for
01026024 Fracture Neck Femur 35000/-
01026025 ProceduresOpenA.O.CompressionNeckReductionFemurfor Fractureof 35000/-
MuscleFracturePedicleNeckGraftFemurand
01026026 ClosedInternalReductionFixationsof 35000/-
01026027 OpenDislocationsReduction of 10000/-
01026028 Dislocations - Superficial 20000/-
Open Reduction of
01026029 Dislocations - Deep 30000/-
Open Reduction of
Fracture Dislocation &
01026030 Internal Fixation 35000/-
01026031 Neurolysis/Nerve Suture 25000/-
01026032 Nerve Repair with Grafting 32000/-

Tendon with Transplant or
01026033 Graft 35000/-
Tendon
Lengthening/Tendon
01026034 Sutures 25000/-
01026035 Tendon Transfer 35000/-
Laminectomy, Excision
01026036 Disc (Prosthesis extra) 40000/-
Laminectomy,Disc and TumoursExcision
0102603701Anterolateral(Prosthesisfor tuberculosisClearanceextra) 32000/-60000/-
DecompressionAntereolateraland
01026039 Spinal Fusion 45000/-
01026040 Costo Transversectomy 30000/-
01026041 InternalCorrectiveFixationOstectomy- Minor& 15000/-
nexure-I
Maximum
Approved
01026042 InternalCorrectiveFixationOstectomy- Major& 30000/-
Arthrodisis of -Minor
01026043 Joints 15000/-
Arthrodisis of -Major
01026044 Joints 30400/-
01026045 SoftSoft TissueTissueC.T.E.V.OperationsOperations forfor 25000/-
01026046 PartialPolio (instrumentationHipextra)Replacement 25000/-
01026047 (CostOperationsof Prosthesisfor Brachialextra) 40000/-
01026048 Plexus & Cervical Rib 32000/-
Amputations -Below
01026049 Knee Rs 25000/-
Amputations - Below
01026050 Elbow 25000/-
Amputations - Above
01026051 Knee 35000/-
Amputations - Above
01026052 Elbow 30000/-
Amputations -
01026053 Forequarter 40000/-
Amputations -Hind
Quarter and
01026054 Hemipelvectomy 44000/-
01026055 Disarticulations - Major 30000/-
01026056 DisarticulationsArthrography- &Minor 20000/-
01026057 SpinalOsteomedullographyOstectomy and 10450/-
01026058 Internal Fixations 40200/-
01026059 SoftArthroscopyTissue Operation- Operativeon 24250/-
01026060 MyocutaneousKnee and 24000/-
01026061 RemovalProceduresFasciocutaneousof Nails,for LimbsWiresFlat & 24000/-
01026062 Screw 10000/-
01026063 TotalRemovalHip Replacement-of Plates 15000/-
01026064 Unilateral (Excluding 60000/-
21
Annexure-I
Maximum
Approved
Implants)
Total Finger Joint
Replacement-Unilateral
01026065 (ExcludingTotal KneeImplants)Joint 23000/-
01026066 Replacement-Unilateral(Excluding Implants) 55000/-
ReplacementAny Other(e.g.Jointelbow,
shoulder, etc.)- Unilateral
01026067 (Cost of Implants extra) 55000/-
Multiple fractures repair
(excludinginjuries)-majorperipheral(abovelimb
01026068 threeimplantsfractures)extra)(cost of 100000/-
(excludingMultiple fracturesperipheralrepairlimb
injuries)-medium (above
two fractures) (cost of
01026069 implants extra) 60000/-
01026070 SternalRepairDehisences 25000/-
01026071 SternalReconstructionDehisences 55000/-
01026072 Fingers (post, slab) 300/-
0102607301CollesFingersFractureelbowfull plaster- Below 1200/-300/-

01026075 Colles Fractureplaster - Full 2000/-
01026076 Collespost.fractureslabAnt. Or 1000/-
01026077 Above elbow full plaster 1000/-
01026078 Above Knee post-slab 700/-
01026079 Below Knee full plaster 1000/-
01026080 Below Knee post-slab 750/-

01026081 Tube Plastercylinder)(or plaster 1450/-
01026082 Above knee full plaster 2400/-

nexure-I
Maximum
Approved
01026083 Above knee full slab 2200/-
01026084 Minerva Jacket 4000/-

01026085 Plaster Jacket 3050/-
01026086 Shoulder spica 3350/-
01026087 Single Hip spica 3100/-
01026088 Double Hip spica 3800/-

01026089 Resection of First Rib 45000/-
01026090 Resection of Cerical Rib 35000/-
01026091 Rib Resection 12500/-
01026092 Ligament Reconstruction 22000/-

027 CraniotomyNeuro-Surgeryand
Evacuation of Haematoma
01027001 -Subdural 70000/-
Craniotomy and
01027002 EvacuationEvacuation-Extraduralof Haematomaof Brain 70000/-
01027003 ExcisionAbscessof Lobe (Frontal, 80000/-
01027004 ExcisionTemporal,ofetc.)BrainCerebeliumTumours 80000/-
01027005 Excision-Supratentotialof Brain Tumours 80000/-
01027006 -Subtentorial 80000/-
01027007 Surgery of Cord Tumours 60000/-

Ventriculoatrial
/Ventriculoperitoneal
01027008 Shunt 40000/-
01027009 ExcisionVertebralof CervicalDiscsInter- 50000/-
Sympathetectomy -
01027010 Lumbar 18000/-
Sympathetectomy -
01027011 Cervical 18000/-
22
Annexure-I
Maximum
Approved
01027012 Twist Drill Craniostomy 30000/-

01027013 Subdural Tapping 15000/-
01027014 Ventricular Tapping 12000/-
01027015 PlacementAbscessofTappingICP Monitor 15000/-

01027016 - 15000/-
Urokinase Therepy for
0102701701Skull TractionICH Application- 15000/-3400/-
01027019 LumberMonitoringPressure 10000/-
01027020 Vascular Malformations 100000/-
01027021 Peritoneal Shunt 15000/-
0102702201MeningoAtrialEncephalocoelShunt 52000/-15000/-
01027024 Meningomyelocoel 42000/-
0102702501C.S.F.CranioplastyRhinorrhaea 55000/-55000/-
01027027 PosteriorDissectomyCervical 50000/-
01027028 AnteriorDissectomyCervical 50000/-
Brachial Plexus
01027029 Exploration Microsuturing 50000/-
Median Nerve
01027030 Decompression 40000/-
01027031 Peripheral(Tirgeminal)Neurectomy 45000/-
01027032 Trigeminal Rhiotomy 35000/-
01027033 Cranial Nerve Astomosis 60000/-
01027034 Meningocoele Excision 45000/-

Peripheral Nerve Surgery
01027035 – Major 50000/-
Peripheral Nerve Surgery
01027036 Minor 40000/-
Ventriculo-Atrial Shunt
0102703701Nerve(Exclud.+ BiopsyInvestigation)Cost(Procedureof valve) 100000/-15000/-
Brain Biopsy (Procedure +
01027039 Investigation) 18000/-
01027040 AnteriorSurgeryCervicalwith fusionSpine 60000/-
nexure-I
Maximum
Approved
Anterior Lateral
01027041 Decompression 60000/-
01027042 Brain Mapping 2400/-
Cervical or Dorsal
01027043 Laminectomy 45000/-
Combined Trans-oral
01027044 SurgeryFusion& CV Junction 110000/-
01027045 C.V. Junction Fusion 80000/-
01027046 Depressed Fracture 40000/-
01027047 Discectomy 45000/-
01027048 R.F. LesionEndarterectomyfor Trigeminal 50000/-
01027049 Neuralgia - 30000/-
01027050 Spasticity Surgery - 90000/-
01027051 SpinalSpinalFusionIntra MedullaryProcedure 65000/-
01027052 SpinalTumoursBifida Surgery 65000/-
01027053 Spina/ BifidaMajorSurgery 65000/-
01027054 StereotaxicMinorProcedures- 55000/-
01027055 biopsy/ aspiration 22000/-
01027056 Trans Sphenoidal Surgery 65000/-
01027057 Trans Oral Surgery 110000/-
Implantation of DBS- one
01027058 Electrode 100000/-
01027059 ImplantationElectrodesof DBS- two 100000/-
Endoscopic
01027060 Adueductoplasty 100000/-
Facial nerve
01027061 reconstruction 50000/-
Recanelisation of venous
01027062 sinuses 80000/-
01027063 Carotid stenting 75000/-
01027064 Cervical disc arthroplasty 35000/-

01027065 Lumbar disc arthroplasty 30000/-
01027066 Corpus Callosectomy 60000/-
01027067 Hemishpherectomy 80000/-

23
Annexure-I
Maximum
Approved
Endoscopic CSF
01027068 rhinorrhea repair 50000/-
Microsurgical excision of
01027069 Acoustic tumour 60000/-
Microsurgical excision of
01027070 meningomas 60000/-
01027071 Epilepsy surgery 80000/-

0102707201LateralRFCervicallesionmasssyndromelaminoplastyforC1-C2facet painscrew 40000/-40000/-
01027074 decompressionMicrosurgicalfixation for 60000/-
01027075 CerebellarTrigemilstimulationnerve for 60000/-
0102707601Cerebellarotherhemifacialneuralgiacranialstimulationspasmnerve for 80000/-80000/-
01027078 IC EC bypass procedures 70000/-
01027079 Stereotacticcraniotomyguided 70000/-
01027080 implantationincludingmovementBaclofenParkinsonismlesioningdisorderpump for 60000/-
01027081 Programmable shunt 40000/-
Endoscopic
01027082 sympathectomy 18000/-
01027083 Externaldrainageventricular 12000/-
Image guided surgery
01027084 Excision of tethored 60000/-
01027085 ventriculostomyEndoscopic 3rd 60000/-
Endoscopic cranial
surgery/Biopsy/aspiration/
01027086 aneurysm coiling 60000/-
01027087 Endoscopic discectomy 60000/-
01027088 Aneurysm coiling 80000/-

Endoscopic spil
01027089 procedure- aneurysm 80000/-
nexure-I
Maximum
Approved
coiling
Surgery for grooving skull
fractures- aneurysm
01027090 coiling 80000/-
Carpel Tunnel
01027091 decompression 40000/-
Clipping of intracranial
01027092 aneurysm with use of clip 90000/-
01027093 StereotacticEndoscopicintracerebellarhaematomaRadiosurgeryaspiration of 60000/-
01027094 forForamenbrainknife/pathologyGamma)magnum(X 120000/-
01027095 decompressionForamendecompressionmagnumwith 60000/-
01027096 Dorsalforsyringosubarachnoidbachachecolumnshuntstimulationin failed 60000/-
01027097 Surgerybackforsyndromerecurrent disc 50000/-
01027098 prolapse/Surgery epiduralfor brainfibrosisstem 60000/-
01027099 hemishphericalDecompressivecranectomytumours foracute 100000/-
01027100 Intra arterialsubduralthrombolysis 70000/-
with RTPA for ischemic
01027101 stroket RTPA-acute 100000/-
01027102 intracerebralStereotactic aspirationhaematomaof 50000/-
01027103 Complex Brain Surgery 130000/-
01027104 Complex Spine Surgery 110000/-
01027105 Dorsal Sympathectomy 50000/-

Neuro rehabilitisation-
package for 25 sittings
01027106 (bed charges extra) 15000/-
028 Vascular Surgery
24
Annexure-I
Maximum
Approved
01028001 Patch Graft Angioplasty 50000/-

01028002 OperationsRenalforArteriesStenosis of 50000/-
01028003 Thrombendarterectomy 50000/-
Operations for Acquired
01028004 Arteriovenous Fistula 50000/-
Congenital Arterio Venous
01028005 Fistula 27700/-
Surgery for Arterial

01028006 Aneursysm -Vertebral 80000/-
01028007 Aneursysm Carotid 42500/-
01028008 AneursysmDissectingof theAneurysmsMainLimbArteries+ 50000/-
01028009 Implant 150000/-
01028010 StrippingSephenousof ShortVeinsor Long 30000/-
Ligation of Ankle
01028011 ExcisionPerforatorsand Skin Graft of 17400/-
01028012 Venous Ulcer 15500/-
01028013 VenousLymphaticsThromoectomyExcision of 22100/-

01028014 SubcutaneousLymphoedemaTissues In 30000/-
01028015 Trendelenburg Operations 30000/-

01028016 VascularMinorProcedure – 16800/-
01028017 Aneursysm Spleen Artery 40200/-
01028018 Aneursysm Renal Artery 40200/-
029 Paediatric Surgery

nexure-I
Maximum
Approved
Excision of thyroglossal
01029001 Duct/Cyst 30000/-
01029002 DiaphragmaticAbdominalRepair (ThoracicApproach)Herniaor 35000/-
TracheoFistula Oesophageal(Correction
01029003 Surgery) 40000/-
Colon Replacement of
01029004 Oesophagus 40000/-
Omphalo Mesenteric Cyst
01029005 Excision 30000/-
Omphalo Mesenteric
01029006 Duct- Excision 30000/-
01029007 Meckels Diverticulectomy 30000/-
01029008 OmphaloceleOmphalocele(Hernia Repair)1st2ndStageStge 28000/-

01029009 (Hernia Repair) 30000/-
01029010 Gastrochisis Repair 24000/-
01029011 Inguinal Herniotomy 24000/-
01029012 Congenital Hydrocele 24000/-
01029013 Hydrocele of Cord 22000/-
01029014 Torsion Testis Operation 25000/-
01029015 Stenosis-Duodenal-CongenitaloperationPyloricAtresia 27000/-
01029016 Operation 35000/-
01029017 Pancreatic Ring Operation 45000/-
01029018 Meconium Ileus Operation 30000/-
01029019 MalrotationOperationof Intestines 32000/-
01029020 Rectal(Megacolon)Biopsy 25000/-
01029021 Colostomy Transverse 28000/-
01029022 Colostomy Left Iliac 28000/-

Abdominal Perineal Pull
Through (Hirschaprugis
01029023 Disease) 35000/-
01029024 Imperforate Anus Low 22000/-
25
Annexure-I
Maximum
Approved
Anomaly -Cut Back
ImperforateOperationAnus Low
Anomaly - Perineal
01029025 InperforateAnoplastyAnus High 28000/-
01029026 AnomalyPerineal-SacroabdominoPull Through 25000/-
01029027 InperforateAnomalyColostomy- AnusClosureHighof 21000/-
01029028 Intususception Operation 35000/-
Choledochoduodenostomy for Atresia of Extra
01029029 Hepatic Billiary Duct 35000/-
01029030 Operation ofCystCholedochal 35000/-
Nephrectomy for -
01029031 Pyonephrosis 35000/-
Nephrectomy for -
01029032 Hydronephrosis 35000/-
01029033 NephrectomyTumourfor -Wilms 35000/-

LymphadenoctomyNephrectomyParaorticfor Wilmswith
01029034 Tumour 40000/-
Sacro- Coccygeal
01029035 Teratoma Excision 30000/-
01029036 NeuroblastomaNeuroblastomaDebulkingTotal 32000/-

01029037 Excision 36000/-
01029038 ColonRhabdomyosarcomaTransplant/Excision Conduitwide 40000/-
Management following
01029039 AcidOesophagusStructure 65000/-
01029040 Umbilical Line 500/-

nexure-I
Maximum
Approved
01029041 Peripheral Long Line 800/-

01029042 LP 300/-
01029043 Peritoneal Tapping 500/-
01029044 Chest Drainage 800/-
01029045 (includingGeneral Nurseryetc.)NursingCareCare 600/-
01029046 NeonatePhototherapyRoomingperindaywith 400/-

01029047 motherof Nursingper day care)(inclusive 600/-
01029048 SNCULaproscopic/Care(SickUnit)New Born 1600/-
Endoscopic Operations
In Gen. Surgery /
030 Gastrohepatic / Nephro-
01030001 Diagnostic Laproscopy 6600/-
Laproscopic
01030002 Pyloromyotomy 18000/-
01030003 Laproscopic Gastrostomy 21000/-
01030004 LaproscopicPerforated pepticClosureulcerof 25000/-
01030005 LaproscopicPyleroplasty/jejunostomyVagotomygastro 24000/-
Laproscopic umbilical
01030006 hernia repair 20000/-
Laproscopic ventral hernia
01030007 repair 25000/-
01030008 Lap.cystogastrostomyCholecystectomyLaproscopic & 30000/-
01030009 CBD exploration 26000/-
01030010 Lap. Hydatidsurgeryof liver 28000/-
01030011 Lap. Hepatic resection 28000/-

Lap. Assisted small bowel
01030012 resection 30000/-
Lap. For intestinal
01030013 obstruction 30000/-
26
NAME OF TREATMENT
CODE PROCEDURE
Lap. For intestinal
01030014 perforation
0103001501Lap.Lap.HemicolectomyHemicolectomyAssistedAssistedRightleft
01030017 Lap.ColectomyAssisted Total
01030018 Laproscopic Rectopexy

Lap. Asisted
Abdominoperineal
01030019 Resection of rectum
Lap. Assisted anterior
01030020 resection
Laproscopic
01030021 Cholecystectomy
Laproscopic
01030022 Appendicectomy
Laaproscopic Hernia
0103002301LaproscopicRepairRepairHiatus Hernia
01030025 Laproscopic Adhesiolysis

Laproscopic
01030026 Adrenalectomy
Laproscopic
01030027 Thyroidectomy
Laproscopic
01030028 Spleenectomy
01030029 Laproscopic Colectomy
01030030 Laproscopic Nephrectomy
0103003101Lap UreterolithotomyOvarianInguinalPyelolithotomy(Laproscopic)LaproscopicCystectomyHernia
01030035 HysterectomyLaparoscopic
01030036 Laparoscopic Ectopic
01030037 Foreign body removal
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees) CODE
28000/- 01030038
32000/-32000/- 01030039
37000/- 01030040
32000/- 01030041
01030042
37000/-
01030043
37000/-
01030044
25000/-
01030045
21000/-
01030046
21000/-30000/- 01030047
01030048
Rs 18000/- 01030049
32000/- 01030050
32000/- 01030051
32000/- 01030052
35000/-
40000/- 01030053
22000/-30000/-22000
01030054031
25000/- 01031001
22000/- 01031002
4000/- 01031003
Maximum
Approved
PROCEDURE (Rupees)
Nephrolithotomy 35000/-
Hydronephrosis-OperationsOperationsPyeloplastyforfor 35000/-
EndopyelotomyHydronephrosis-antegrade 35000/-
Operations for Cyst of the
Kidney 40000/-
URSL 25000/-
Nephroureterectomy 50000/-
Operations for Vesico-
ureteric Reflux 40000/-
Diverticulectomy 22000/-
Repair of Ureterocoel 35000/-

OperationsOperationsPalomo’s-forforUnilateralVaricoceleVaricocele 20000/-
Palomo’s- Bilateral 30000/-
Nephrostomy 16000/-
Orchidopexy- Unilateral 25000/-
Orchidopexy- Bilateral 30000/-
Prostratectomy 45000/-
Laparoscopic Uro stone 30000/-

RadioIncisionalNuclearRadiotherapyChemotherapy(packages)IsotopeMedicines-HernioplastyTherapy& 35000/-
131- Iodine15mCiTherapy < 5200/-
131- IodinemCiTherapy 15-50 16900/-
131- Iodine100 TherapymCi 51- 16900/-
27
Annexure-I
Maximum
Approved
131- Iodine Therapy >
01031004 100mCi 19500/-
01031005 Strontiummetastaticpalliationtherapybone painfor 7200/-
Samarium-153metastatic bonetherapypainfor
01031006 palliation 10700/-
032 Cobalt 60 Therapy
01032001 Radical Therapy 70000/-
01032002 ImmobilisationAdjustment Therapy-technique 16000/-
01032003 Palliativethan 10Therapyfractions)(less 15000/-
01032004 Palliativefractions)Therapy (10-25 25000/-
01032005 Palliativefraction)Therapy (single 5000/-
033 Linear Accelerators

01033001013-D2-D PlanningPlanningCobalt-60)Cobalt-60)(L.(L. Acc.Acc. oror 6000/-5000/-
01033003 IntensityTherapyModulated(IMRT)Radio 105000/-
01033004 ImageTherapyGuided(IGRT)Radio 150000/-
01033005 IGRT Single Fraction 7000/-
01033006 3D-CRTTherapy)(Confirmal Radio 65000/-
01033007 3D-CRT with IGRT 75000/-
01033008 4D-CRT with IGRT 90000/-
01033009 StereotacticSurgery (SRS)Radio 85000/-
01033010 StereotacticTherapy (SRT)Radio 70000/-
01033011 Rapid Arc with IMRT rate 100000/-
01033012 TherapyPalliativeuptoRadiation15 fractions 25000/-
nexure-I
Maximum
Approved
Palliative Radiation
01033013 Therapy upto 25 fractions 35000/-
01033014 PalliativeConventionalfractionRadiationRadiationsingle 10000/-
01033015 ConventionalTherapy withRadiationCT 35000/-
01033016 Therapy CBCT 45000/-
interventionalSRS/ SRT Neurocharge/
01033017 ElectroncaseBeam (>10 10000/-
01033018 ElectronFractions)Beam (<10 40500/-
01033019 Fractions) 9000/-
01033020 Pre-radiation profile 2500/-
034 BrachyIntra CavitaryTherapy
Brachytherapy- 1st
01034001 insertion 5500/-
01034002 Luminal2ndIntraInterstitialandCavitary/insertionBrachytherapy-subsequentBrachyIntra 3000/-
01034003 Therapy-Interstitial1stBrachyinsertion 15000/-
01034004 Therapy- 2nd insertion 10000/-
035 Chemotherapy
01035001 Neoadjuvant 1000/-
01035002 Adjuvant 1000/-
01035003 ChemotherapyInfusional Chemotherapywafers for 1000/-
01035004 Multiplemalignantdrugbraintherapytumoursper 20000/-
01035005 day 900/-
01035006 Targeted therapy 1000/-
01035007 Chemoport facility 1000/-
28
NAME OF TREATMENT
CODE PROCEDURE
PICC line (Peripherally
Inserted Central
01035008 Canulisation)
036 Room Rent
01036001 General Ward
01036002 Semi-Private Ward
01036003 Private Ward
Day Care/ Minor (OPD)
01036004 Surgeries (all categories)
Admissible Blood
Charges
For treatment in
037 Government Hospitals
01037001 General Beds
01037002 Paying Beds
01037003 Cabin
For treatment in
recognised Private
Hospitals/ Nursing
Homes/ Aided
038 Institurions
01038001 Whole Blood
01038002 F.F.P.
01038003 Platelet Concentrate
01038004 Platelet Rich Plasma
01038005 Packed Cell
01038006 Frozen Plasma
01038007 Crypoprecipitate
01038008 Washed RBC
Annexure-I
cheme, 2008
Maximum
Approved
Rate (INR)
(Rupees)
1000/-
(Per day)
600/-
1200/-
1800/-
600/-
50/-
100/-
140/-
500/-
400/-
400/-
400/-
400/-
350/-
300/-
400/-
29
RATES OF INVESTIGATIONS :
02 – INVESTIGATIONS
CODE INVESTIGATIONNAME OF
02001001001
AspirationGeneralPlural Effusion -
Diagnostic
02001002 AbdominalDiagnosticAspiration -
02001003 BonePericardialMarrowAspirationAspiration
02001004
02001005 JointsE.C.G.Aspiration
02001006
02001007 E.E.G.
02001008 StressLumbartestpuncture(TMT)
02001009
02001010002
SternalE.N.T.puncture
02002001 Pure Tone Audiogram

02002002 ImpedenceSISI, Tone& Decayother tests&
02002003 Difference times
assessmentMultipletesthearingto Adults
02002004
02002005 Hearing Aid Selection
02002006 Hearing Aid Analysis
02002007 Speech DiscriminationScore
02002008 Speech Assessment
02002009 ColdVestibularCaloriefunctionTest for
02002010 Audiometry (MHC)

02002011 ABR (Threshold Est.)
02002012 Acoustic Reflex Decay
02002013 Eustachian Tube Func
02002014 IMP Audiometry
02002015 Otoacoustic Est. (OAE)
02002016 PEAD Audio Assessment

02002017 SRT & SDS
02002018 Swallowing Assest
Annexure-I
Maximum
Approved
NAME OF Rate (INR)
CODE INVESTIGATION (Rupees)
Maximum 02002019 Tympanometry 150/-
Approved 02002020 Voice Assest 250/-
Rate(Rupees)(INR) 02002021 Endo Laryngoscopy 850/-
02002022 ENG 1300/-
02002023 Nasal Endoscopy 600/-
750/- 02002024 Nasopharyngoscopy 600/-
900/- 02002025003 LV DyssynchronyEye Study 1400/-
1200/-800/- 02003001 Refraction/Fundoscopy 150/-
02003002 Ortho-optic check up 150/-
750/-140/- 02003003 Perimetry/field test 400/-
02003004 Clinical Photography 100/-
800/- 02003005 Electrooculogram 500/-
1000/-850/- 02003006 ERG 400/-
02003007 Flourescein Angioraphy 800/-
800/- 02003008 A-Scan 200/-
02003009 Tono Graphy 450/-
300/- 02003010 VER 300/-
300/- 02003011 Goldmen Perimetry 150/-
250/- 02003012 SpecularIndo cyaningreenmicrosopy 200/-
450/- 02003013 Angiography of Retina 1000/-
Indo cyaningreen 1000/-
100/- 02003014 Angiography - IRIS
400/- 02003015 CornealAutomatedendothelialPerimetrycell 450/-
200/- 02003016 count 200/-
200/- 02003017 Corneal topography 200/-
180/- 02003018 RetinalCornealnervepachymetryfilm analyzer 200/-
100/-
250/- 02003019 studies
650/- 02003020 Auto Refrectemetry 60/-
100/- 02003021 UltrasoundBiometrystudies - A 180/-
100/- 02003022 Scan 600/-
300/- Ultrasound studies -- B 600/-
550/- 02003023 Scan
Retinal/Meter function 150/-
200/- 02003024 studies
150/- 02003025 PAN ACUITY METER 200/-
30/-
30
NAME OF
CODE INVESTIGATION
02003026 Laser interferometry
02003027 EKG, EOG
02003028 DacryocystographyOrbital Angio studies(DGC)
02003029 Digital Biometry Reading
02003030 Biometry(Single)(Both Eye)
02003031
02003032 Biometry-corp (Both)
02003033 Biometry-corp-Single
02003034 Pachymetry (Both Eye)
02003035 MultifocalPachymetryERG (Single)(One Eye)
02003036 NCT
02003037 OCT- NFL Analyser
02003038 Schiotz Tonometer
02003039
02003040 TTT
02003041 VEP
Anterior Segment (Fundus)
02003042 Photography
02003043 USG
004 Physiotheraphy
02004001 Musclediagnostictesting and
005 Dental
02005001 Intra oral X-ray (Digital)
02005002 Opg Cephalogram
02005003 Opg Standard View
02005004 Radio Visiograph (per
Image)
006 Genetics
Fragile X Decet & Karyo of
02006001 Peri Bld Cell
007 X-Ray (Digital X Ray)
02007001 Fluroscopy chest
02007002 Occlusal
Abdomen AP or Erect (one
02007003 Abdomen Lateralfilm) view (one
02007004 film)
02007005 Abdomen for Pregnancy
Annexure-I
Maximum Maximum
Approved Approved
Rate (INR) NAME OF Rate (INR)
(Rupees) CODE INVESTIGATION (Rupees)
1000/- 02007006 Chest PA view (one film) 130/-
500/- 02007007 Chest Oblique(One film)or Lateral 130/-
500/-500/- 02007008 Mastoids (one film) 150/-
180/- 02007009 Extremities,(onebonesfilm) & Joints 140/-
350/- 02007010 Pelvis (One film) 140/-
Paranasal sinuses (One 140/-
400/- 02007011 film)
300/- 02007012 T.M. Joints (One film) 140/-
400/- 02007013 AbdomenK.U.B.& pelvis for 250/-
800/-200/- 02007014 Skull A.P. & Lateral 250/-
160/- 02007015 Spine A.P. & Lateral 250/-
1600/- 02007016 Barium Swallow 700/-
250/- 02007017 Sinography/ Sialography 750/-
Cystography/ 1120/-
2500/- 02007018 Urethrography
600/- 02007019 Hystero-Salpaingography 1110/-
300/- 02007020 Arthrography 840/-
02007021 Retrograde Pyelography 1080/-
550/- Oral or I.V. 720/-
02007022 Cholecystography
100/- 02007023 BariumBariumMealEnemaUpper or 1160/-
960/-
02007024 Lower
80/- 02007025 Bronchography 1260/-
210/- 02007026 I.V. Urography/ I.V.P. 1350/-
210/- 02007027 Myelography 1500/-
110/- 02007028 Pneumo Encephalography 1120/-
02007029 Barium meal Complete 1230/-
Cerebral/Femoral 2000/-
02007030 Angiography
3500/- 02007031 Periapical X-Ray 100/-
Barium Enema (Double 1300/-
120/- 02007032 Cont.)
130/- 02007033 Barium IC Junction 750/-
130/- 02007034 Gastro Conray Meal 750/-
02007035 Intravenous Pyelogram 1400/-
130/- 02007036 T-Tube Cholangiogram 700/-
130/- 02007037 PTBD Gram 700/-
02007038 Micturating 750/-
31
NAME OF
CODE INVESTIGATION
Cystourethrogram (MCU)
02007039 VUR/ Cystourethrography
02007040 Small Bowel Enema
Anymachine-addlXRAY usinghandlingportable
02007041 charge
Any other XRAY- single
02007042 Film (Small)
Any otherFilm XRAY-(Large)single

02007043
008 Conventional X-Ray (70%
of Digital X-Ray rates)
02008001 Fluroscopy chest
02008002 Occlusal
02008003 Abdomen APfilm)or Erect (one
Abdomen Lateral view (one
02008004 film)
02008005 Abdomen for Pregnancy
02008006 Chest PA view (one film)

Chest Oblique or Lateral
02008007 (One film)
02008008 Mastoids (one film)
Extremities, bones & Joints
02008009 (one film)
02008010 ParanasalPelvis (Onesinusesfilm)(One
02008011 film)
02008012 T.M. Joints (One film)
02008013 AbdomenK.U.B.& pelvis for
02008014 Skull A.P. & Lateral
02008015 Spine A.P. & Lateral
02008016 Barium Swallow
Sinography/ Sialography
02008017
02008018 UrethrographyCystography/
02008019 Hystero-Salpaingography
02008020 Arthrography
02008021 Retrograde Pyelography
02008022 CholecystographyOral or I.V.
Annexure-I
Maximum Maximum
Approved Approved
02008023 Barium Enema 810/-
2600/- 02008024 Barium MealLowerUpper or 670/-
1150/- 02008025 Bronchography 880/-
300/- 02008026 I.V. Urography/ I.V.P. Rs 950/-
02008027 Myelography Rs 1050/-
02008028 Pneumo Encephalography 780/-
130/- 02008029 Barium meal Complete 860/-
Cerebral/Femoral
160/- 02008030 Angiography 1180/-
02008031 Periapical X-Ray 70/-
Barium Enema (Double
02008032 Cont.) 910/-
90/- 02008033 Barium IC Junction 530/-
90/- 02008034 Gastro Conray Meal 530/-
90/- 02008035 Intravenous Pyelogram 980/-
90/- 02008036 T-Tube Cholangiogram 490/-
02008037 PTBD Gram 490/-
90/- Micturating
02008038 Cystourethrogram (MCU) 530/-
90/-
90/- 02008039 VUR/ Cystourethrography 1820/-
02008040 Small Bowel Enema 810/-
100/- Any XRAY using portable
90/- 02008041 machine-addlchargehandling 300/-
90/-90/- 02008042 Film (Small) 90/-
90/- Film (Large) 110/-
170/- 02008043009 InvestigationsUltrasound
160/- Obstetric First Scan/
170/- 02009001 Follow up 500/-
490/- USG: Lower Abdomen/ 800/-
520/- 02009002 Pelvis
Upper abdomen First
780/- 02009003 Scan/Ultrasound-Follow up 600/-
Rs 780/- 02009004 Neurosonogram 900/-
590/- USG- Neurosonogram- 350/-
760/- 02009005 Screening
510/-
32
NAME OF
CODE INVESTIGATION
02009006 TotalMultipleAbdominalorgansurveystudy or
02009007 SpecialAspirationproceduresetc. &
02009008 Image Intensifiers
02009009 USG: Neck
02009010 USG: KUB
02009011 USG: Whole Abdomen

USG: Whole Abdomen +
02009012 Transrectal
02009013 USG: Scrotum
02009014 USG: Testis
Ultrasound Bladder
02009015
02009016 Ultrasound Kidney/ Renal
02009017 USG: Pregnancy + Doppler
02009018 USG: Joint (Unilateral)
02009019 USG: Joint (Bilateral)

02009020 USG: Musculoskeletal
02009021 USG: Transrectal
02009022 USG: Breast Unilateral
02009023 USG: Breast Bilateral
02009024 USG: Thyroid
02009025 USG: Chest
USG: Prostate
02009026 USG: Single Organ
02009027 USG: Follicular Study
02009028 USG: Guided Procedure
02009029 USG: FNAC
02009030 USG: Follow-up Ovulation
02009031 USG: For Congenital
02009032 Anomaly
02009033 Ultrasound Parotid
02009034 Ultrasound Thigh
Any USG using portable
02009035 machine- handling charge
010 ClinicalUrinePathologyroutine
02010001 Quantitative Albumin/Sugar
02010002 Urine Bile Pigment and
02010003
Annexure-I
Maximum Maximum
Approved Approved
950/- 02010004 Urine UrobilinogenSalt 50/-
1230/- 02010005 Urine Ketones 50/-
02010006 Urine Occult Blood 50/-
700/-
02010007 Urine total proteins 100/-
850/-
02010008 Urine Sodium 100/-
800/-
02010009 Urine Chloride 100/-
950/-
1500/- 02010010 Bence Jones protein 90/-
02010011 Stool routine 60/-
900/- 02010012 Stool occult blood 60/-
600/- Post coital smear 100/-
600/- 02010013 examination
02010014 Smear analysis 100/-
600/- Body fluid (CSF/Ascitic
2200/- Fluid etc.) Chemistry, 240/-
900/- 02010015 Sugar, Protein etc.
Body fluid for Malignant
1800/- 02010016 cells 200/-
800/- 02010017 Urinary Porphobilinogen 110/-
800/- 02010018 Urinary Myoglobin 400/-
700/- Urine for 3500/-
1050/- 02010019 ImmunoelectrophoresisUrine for Protein
800/- 02010020 Electrophoresis 2800/-
700/- CRK ISO Enzyme 5000/-
550/- 02010021 Electrophoresis
550/- 02010022 Hb Electrophoresis 600/-
1250/- 02010023 Chyle Test 100/-
600/- 02010024 Semen Analysis 280/-
900/- 02010025 IVF Semen Analysis 250/-
600/- 02010026 Stool Reducing Substance 60/-
1800/- 02010027 Stool for OVA, Parasite 70/-
02010028 Stool for Parasite 60/-
800/- 02010029 Stool Culture & Sensitivity 200/-
800/- Urine for Culture & 250/-
200/- 02010030 Sensitivity
02010031 KaryotypeAnalysisChromosome 2400/-
60/- 02010032 Genotyping 5000/-
50/- 02010033 Glucotyping 5000/-
50/- 02010034 Urine for Electrolytes 200/-
33
NAME OF
CODE INVESTIGATION
02010035 Urine Amino-aciduria
02010036 Urine for Phosphorus
02010037 UrineUrineProtein/Creatininefor Z-N Stain
02010038 Ratio
02010039 Opiates SerumUrine Random
02010040 OpiatesUrine AmminoRandomAcid,Urine
02010041 Qualitative, 2 Dimensional
02010042 Pre/Post-DialysisCreatinine
02010043 Pre/Post-DialysisPotassium
02010044 Pre/Post-Dialysis Sodium
02010045 Pre/Post-Dialysis Urea
011 Haematology
02011001 Haemoglobin (Hb)
Total Leucocytic Count
02011002 Differential(TLC)Leucocytic
02011003 Count (DLC)
02011004 E.S.R.
02011005 Total Red Cell count
02011006 Platelet count
02011007 Reticulocyte count

02011008 Absolute Eosinophil count
02011009 Packed Cell Volume (PCV)

02011010 PeripheralExaminationSmear
02011011 SmearBleedingfor &MalariaClottingparasiteTime
02011012
02011013 ClotR.B.C.RetractionFragilityTimeTest
02011014
02011015 Foetal HaemoglobinL.E. Cell (Hb-F)
02011016
02011017 ProthrombinComplete HaemogramTime (P.T.)
02011018
02011019 BoneExminationMarrow Smear
02011020 Partial Thromboplastin
Annexure-I
Maximum Maximum
Approved Approved
150/- Glucose 6 Phosphate 220/-
220/- 02011021 Dehydrogenase (G, 6PD)
250/-60/- 02011022 P.C.V. Haematocrit 50/-
450/- 02011023 RBC Folate 1350/-

450/-700/- 02011024 Whole Blood Folate 1350/-
100/- 02011025 Sickling Test 120/-

100/- Bleeding Time 40/-
100/- 02011026
80/- Clotting Time 40/-
02011027
50/- D-Dimer Semi Quantitative 900/-

02011028
50/-50/- 02011029 Scurose Lysis Test 280/-
50/- 02011030 Red CellwithOsmoticIncubatoFrag. 280/-

60/-
80/- Heinz Body Test 120/-
02011031
70/-
60/- Fibrinogen 400/-
02011032
50/-
70/- 02011033 FDP 150/-
70/-60/- Plasma Haemoglobin 190/-
02011034
100/-50/- Factor VIII Studies 1000/-
02011035
250/-120/- 02011036 Factor IX Functional 1200/-
150/-180/- 02011037 Factor V Functional 2500/-
400/- 02011038 Factor VAnalysisLieden Mutation 4000/-

200/-
34
NAME OF
CODE INVESTIGATION
TC, DC, ESR
02011039
02011040 AbsoluteCountLymphocytes
02011041 HB, TC, DC
02011042 Bone Marrow [Perls Stain]
02011043 Cell Type & Cell Count
02011044 NasalEosinophilsSmear for
02011045 CSF Cell Counts [TC/DC]

02011046 Complete[CBP]Blood Picture
02011047 MCV MCH MCHC
02011048 Investigation of ABO/RH
02011049 Sinovial Fluid for Analysis
Blood Parasites
02011050
02011051 Malaria Parasite
Malarial Antigen Detection

02011052
02011053 Filaria Antigen W. Bancrofti
Lap Score
02011054
BAL Cell Count

02011055
02011056 Cold Agglutination

Annexure-I
Maximum Maximum
Approved Approved
120/- AT III 650/-
02011057
80/- 02011058 AT III Anti Thrombin 650/-
120/- 02011059 Absolute Neutrophil Count 50/-
750/- 02011060 Osmotic Fragility 120/-
320/- 02011061 HLA Typing 10000/-
90/- 02011062 T-Cell Cross Matching 5000/-
Karyotyping for Bone 6000/-
170/- 02011063 Marrow Cancer (REL
180/- 02011064 Sucrose Lysis Test 120/-
02011065 APTT (50:50) 200/-
180/- Immunofixation 7200/-
02011066 Electroporesis
360/- 012 Blood Bank
02012001 Blood Group & RHO Type 140/-
400/- 02012002 Cross match 50/-
Packed Cells- Proc. 450/-
70/- 02012003 Charges
Saline Washed Packed 450/-
02012004 Cells: Proc. Charges
70/- Coomb’s Test Direct/ 200/-
02012005 Indirect
320/- 02012006 Australia Antigen 200/-
02012007 RHO, Antibody titer 250/-
560/- 02012008 Platelet richChargesPlasma-Proc. 450/-
Whole Human Blood-I.P.- 450/-
400/- 02012009 Proc. Charges
Fresh frozen Plasma: Proc. 450/-
02012010 Charges
100/- Cryoprecipitate: Proc. 450/-
02012011 Charges
Platelet Concent- Proc. 450/-
150/- 02012012 Charges
Therapeutic Phlebotomy: 450/-
02012013 Proc. Charges
35
NAME OF
CODE INVESTIGATION
02012014 GranulocyteChargesConc.: Proc.
013 Bio-Chemistry
Glucose blood- Fasting/
02013001 PP/ Random
02013002 Blood UreaUreaNitrogen/ Blood
02013003 Serum Creatinine
02013004 Serum Uric Acid
02013005 Serum Bilirubin total/ direct

02013006 Serum Iron
02013007 Serum Cholesterol
02013008 Total Iron Binding Capacity
02013009 CK MB
02013010 Serum Calcium
02013011 Serum Phosphorus
02013012 Total Protein Alb/Glo Ratio
S.G.P.T.
02013013 S.G.O.T.
02013014
02013015 Serum amylase
02013016 Serum Electrolyte
02013017 Triglyceride
02013018 Glucose Tolerance(GTT) Test
02013019 C.P.K.
L.D.H.
02013020
02013021 L.D.-1
LDH & LD-1
02013022
02013023 T3
02013024 T4
TSH
02013025
02013026 T3, T4, TSH
FSH
02013027
02013028 LH
02013029 FSH & LH

Prolactin
02013030
02013031 Blood gas analysis
02013032 Blood electrolytesgas analysis with
Annexure-I
Maximum Maximum
Approved Approved
450/- 02013033 Cortisol 650/-
02013034 HDL Cholestrol 200/-
70/- 02013035 VLDL Cholesterol 170/-

02013036 ALDL 480/-
80/- 02013037 Lipid Profile 700/-
02013038 LFT [Liver Function Test] 750/-
100/-
02013039 Alkaline Phosphatase 150/-
110/-
02013040 Acid Phosphatase 300/-
130/- Leucocyte Alkaline
220/- 02013041 Phosphatase Score 600/-
120/- 02013042 Serum Magnesium 170/-
300/- 02013043 Serum Copper 500/-
390/- 02013044 Serum Lithium 250/-
120/- 02013045 Serum Lipase 250/-
120/- 02013046 Serum Chloride 150/-
140/- Serum Inorganic 160/-
120/- 02013047 Phosphorous
120/- 02013048 Serum Ceruloplasmin 750/-
Serum
250/- 02013049 Carbamazepine/Tegretol 1400/-
250/- 02013050 Carbamazepine 600/-
220/- 02013051 Serum Calcitonin 1400/-
300/- 02013052 Calcitonin 1200/-
02013053 Myoglobin Serum 2400/-
270/-
210/- 02013054 Serum C Peptide 800/-
02013055 Serum C Peptide (PP) 500/-
320/-
470/- 02013057 Serum Eption/Phenytoin 700/-
02013058 Albumin (Serum) 120/-
300/-
02013059 Serum Ferritin 720/-
300/-
300/- 02013060 Serum B12 Level 600/-
02013061 Serum Sodium 240/-
700/-
420/- 02013062 Serum Folate 720/-
02013063 Folate & Vitamin 12 Serum 1100/-
410/-
02013064 Serum Aldolase 400/-
670/-
470/- 02013065 Serum Acetaminophen 650/-
02013066 Serum Growth Hormone 550/-
400/- Parathyroid Hormone
500/- 02013067 (PTH), Intact 1200/-
02013068 Serum Osmolality 250/-
36
NAME OF
CODE INVESTIGATION
02013069 Serum Potassium
02013070 SerumSerumParathormoneTIBC
02013071 Serum Homocystine/Level
Homocystine/ Homocystine
02013072 SerumLevelIndividual
02013073 Phospolipids-TLC
02013074 Serum/PlasmaSerum HaptoglobinBicarbonate
02013075 Serum Testosterone
02013076 Serum Thyroglobulin
02013077
02013078 Lactate Plasma
02013079 CA-19-9CA 125
02013080 CA 15.3
02013081 CA 72.4 Gastric Cancer
02013082 Marker
02013083 CSF Sugar
02013084 CSF Protein

02013085 LactateCSF Protein(CSF)
02013086 CSF-OligoclinalElectropherisisBand
02013087 CSF forAnalysisBiochemical
02013088 Analysis
02013089 CSF Chloride
02013090 SodiumCSFBicarbonateProfile
02013091 Mucopolysaccharidoses
02013092 Renin(MPS)ActivityScreeningPlasma,U
02013093 PlasmaPRAAmmonia
02013094 Fructosamine
02013095 GGT-Gamma Glutamyl
02013096 Transaminase
02013097 Globulin
02013098 Estradiol
02013099 Estradiol (E2)
Annexure-I
Maximum Maximum
Approved Approved
150/- 02013100 Glycosylated[HBA1C]Haemoglobin 520/-
900/-280/- 02013101 Alpha I Anti Trypsin Assay 1200/-
02013102 Insulin-P.P./RandomFasting/ 650/-
750/- 02013103 Lactose Tolerance Test 550/-
02013104 SerumDHEA-SDigoxin/(Sulphate)Serum 800/-
450/- 02013105 Digoxin Level 700/-
850/-350/- 02013106 Serum Gastrin 900/-
500/- 02013107 Progesterone 450/-
1360/- 02013108 Beta HCG (B-HCG) 650/-
Beta HCG Quantitative
550/- 02013109 TrophoblasticMarkerCancer 600/-
1000/-800/- 02013110 Cardiac Enzymes 450/-
160/- 02013111 LDH Heat Stable Fraction 640/-
1050/- 02013112 LDH Isoenzymes 1430/-
02013113 AntiphospolipidIGG & IGMAntibody 1050/-
100/-
Antiphospolipid Antibody
100/- 02013114 IGM 750/-
800/-400/- 02013115 Anti-Sperm Antibody/ ABS 550/-
02013116 Alpha-FetoCancerProteinMarker(AFP) 650/-
2000/- 02013117 Carcino Embryonic[CEA] Antigen 600/-
280/- 02013118 Anti-Thyroid Antibodies 950/-
150/- 02013119 Anti-ThyroidAbAntibodies-TG 900/-
3200/-100/- 02013120 Bicarbonate 150/-
500/- 02013121 Anti CardiolipinIgG/ IgMAntibody- 650/-
4000/- 02013122 Anti CardiolipinProfile Antibody 1700/-
400/- 02013123 C_Peptide Assay 350/-
200/- 02013124 Cyst Fluid for Analysis 350/-
320/- 02013125 Trop-T 820/-
02013126 Troponin T-Qualitative 400/-
120/- 02013127 Intracellular Calcium 120/-
520/- 02013128 Pleural/ PeritonealSugar Fluid for 80/-
420/- Peritoneal Dialysis Fluid for 220/-
02013129 Sugar & Urea
37
NAME OF
CODE INVESTIGATION
02013130 Apolipo Proteins
02013131 BloodFreeAcetone/KetoneTestosterone
02013132
02013133 Pleural Fluid for Protein
02013134 Pleural Fluid for LDH
02013135 Pleural Fluid for Amylase
02013136 Fluid for LDH
02013137 Fluid for Amylase
02013138 Fluid for Creatinine
02013139 Fluid for Lipase
02013140 Fluid for Cholesterol
02013141 Phenytoin Level
02013142 24KetogenicH KetosteroidSteroid&
Angio Tension Converting
02013143 Enzyme (ACE)
02013144 Phenobarbitone
02013145 Anti ThyroidTPO AntibodiesAb
02013146 AntiACTHTG
02013147
02013148 ACTH Plasma
02013149 Intact PTH
02013150 IGFI
02013151 IGF-IB-2(Somatomedin-C)Microglobulin
02013152
02013153 Valproic Acid
02013154 Valproate
02013155 Sex Hormone Binding
02013156 Vitamine B-12 Level
02013157 Vitamin D 25 Hydroxy
02013158 17 HydroxyLipoproteinCorticostiroids(a)
02013159 Synovial Fluid for
02013160 Biochemistry
02013161 Plasma Catecholamines
02013162 Serum IgA
02013163 Serum IgG
02013164 Serum IgM
Annexure-I
Maximum Maximum
Approved Approved
500/- 02013165 PericardialBiochemistryFluid for 360/-
240/-600/- 02013166 Pericardial Fluid Test 100/-
Peritoneal Fluid- 450/-
80/- 02013167 Biochemistry
200/- 02013168 Aldosterone 1150/-
180/- 02013169 Galactosemia Profile 1800/-
160/- 02013170 FISH (NH) 2800/-
130/- 02013171 FISH for BCR/ ABL 3200/-
110/- 02013172 Fluid for TVPCR 1400/-
130/- 02013173 Serum Cortisone 380/-
150/- 02013174 Transferrin 780/-
720/- 02013175 Chromogranin A 5000/-
1700/- 02013176 Cryo Globulin Screening 780/-
780/- 02013177 Cocaine Metabolite Screen 500/-
02013178 Cyclosporine CO 1600/-
720/- 02013179 Cytokeratin/ Erythropoietin 1200/-
900/- 02013180014 ProteinHistopathologyC/ S, Functional 2800/-
550/-960/- 02014001 Pap Smear 240/-
Histopathology exam per
960/- 02014002 tissue type 250/-
700/- 015 Bactriology & Serology
350/- 02015001 Smearexaminationgram-strain 100/-
2800/-960/- 02015002 Sputum smear A.F.B. stain 100/-
Vaginal Smear 100/-
520/- 02015003 Examination
520/- 02015004 V.D.R.L. 120/-
1200/- 02015005 Widal test 180/-
800/- 02015006 Rheumatoid Factor test 300/-
1400/- 02015007 Culture specimens)& Sensitivity (other 250/-
400/-580/- 02015008 Urine pregnancy test 200/-
02015009 C.R.P. 220/-
480/- 02015010 ASO Titer 250/-
5500/- 02015011 Quantitative H.C.G. 400/-
220/- 02015012 Blood culture & sensitivity 250/-
220/- 02015013 Vibro cholera culture 250/-
400/- 02015014 CAPD Fluid for Culture & 350/-
38
NAME OF
CODE INVESTIGATION
Sensitivity
CAPD Fluid for Fungal
02015015 Stain/ Gram Stain
02015016 CAPD Fluid-Cytology
02015017 Rapid Urease Test
02015018 ASO (Antistreptoysin “O”)
02015019 High Sensitivity-CRP
02015020 PUS for Fungal Culture
02015021 PUS for Fungal Stain
02015022 PUS for Gram Stain
02015023 PUS for Z-N Stain
02015024 Culture & Sensitivity [PUS]
02015025 CultureCulture& Sensitivity& Sensitivity[CSF]
02015026 [Semen]
02015027 CultureCulture& Sensitivity& Sensitivity[Fluid]
02015028 Culture[Sputum]& Sensitivity
02015029 [Throat Swab]
02015030 CultureVaginal& SensitivitySwab for
Culture & Sensitivity for
02015031 CultureAspirated& SensitivityFluid
02015032 Wound[WoundSwabSwab]for Fungal
02015033 Wound SwabStainfor Gram
02015034 Stain
02015035 WoundCultureSwab& Sensitivityfor Z-N Stain
02015036 [Rectal Swab]
02015037 NailNailforClippingFungalforCultureKOH
02015038 preparation
02015039 Blood CultureAnaerobic& Sensitivity-
02015040 SensitivityBlood for(Paediatric)Culture &
Tissue for Culture &
02015041 Mitral SensitivityValve Tissue for
02015042 AorticCultureValve& SensitivityTissue for
02015043
Annexure-I
Maximum Maximum
Approved Approved
Arterial Line Tip for Culture

100/- 02015044 & Sensitivity 250/-
200/- 02015045 Ascitic FluidSensitivityfor Culture & 600/-
250/- AC Tap for Culture &
360/- 02015046 Sensitivity 250/-
400/- 02015047 Sputum for AFB Culture 500/-
250/- 02015048 Sputum for Fungal Culture 150/-
100/- 02015049 Sputum for Fungal Stain 100/-
100/- 02015050 Sputum for Z-N Stain 100/-
100/- 02015051 Sputum for Grams Stain 100/-
250/- 02015052 EsophagealCandidaSmear for 150/-
250/- 02015053 UrinePleuralforFluidAFBforCultureAFB 500/-
250/- 02015054 Culture 500/-
250/-250/- 02015055 CulturePleural AFBFluid-AntibioticTBPCR 1200/-
02015056 Sensitivity- 5 Drug Panel 3000/-
250/- 02015057 Urine for Gram Stain 100/-
250/- 02015058 Throat Swab for KLB 100/-
02015059 Fungus Culture 150/-
250/- 02015060 Clostridium Difficile&B Toxin A 1200/-
250/- 02015061 YeastSusceptibilityIdentification and 350/-
100/-100/- 02015062 SerologyNonIdentificationFermenterfor Mumps 300/-
02015063 IGM/IGG 1000/-
100/- 02015064 Torch Profile 1500/-
250/- 02015065 SerumEnzy.Angitens.AssayConv. 400/-
100/-200/- 02015066 P-ANCA 800/-
02015067 C-ANCA 800/-
600/- 02015068 ElisaAldehydeTest forSerumEcinococcusTest 80/-
600/- 02015069 Antibody Detec 600/-
02015070 Ascitic Fluid Cell Count 200/-
250/- 02015071 AntiAustralia-Antigen)HBS (Antibody to 400/-
250/- 02015072 HepatitisAntibodyB Surface 400/-
250/-
39
NAME OF
CODE INVESTIGATION
02015073 Anti-HBC CoreIgM Antibody
02015074 Serum Immunoglobulin
02015075 Immunoglobulin IGE
02015076 IGE Allergy Individual
02015077 Immunoglobulin-IGA
02015078 Immunoglobulin IGM
02015079 Anti-HAV-IGM-AntibodyImmunoglobulin IGG
02015080
02015081 Compliment C3
02015082 Compliment C4
02015083 Toxoplasma- IgG
02015084 Toxoplasma- IgG
02015085 Toxoplasma- IgG + IgM

02015086 CysticercosisAntibodyAntibody/IgG
02015087 Cytomegalovirus, PCR

02015088 PCR for AFB
02015089 Herpes I(IgG)(HSV Type I)
Herpes I(IgM)(HSV Type I)
02015090
02015091 Herpes II (IgG)(HSVII) Type
Herpes II (IgM)(HSV Type
02015092 II)
02015093 Herpes I + II (IgG)
Herpes I + II (IgM)
02015094
TPHA (Treponema
02015095 Pallidum Haemagglutinat
02015096 Hydatid CystHBsAgfor IgG Elisa

02015097
02015098 Aspergillus(IGG/IGM)Antibody
02015099 Anti HCV IgG/IgM
02015100 Anti HEV IgG/IgM
02015101 Allergy Screening- Adult
02015102 DengueDengueAntibodiesElisa IgG +
02015103 IgM
02015104 Dengue NS1 Ag Test
02015105 Screening for C-Pylori
Annexure-I
Maximum Maximum
Approved Approved
550/- Elisa for[RUT]Tuberculosis
600/- 02015106 [IGG/IGM/IGA] 350/-
500/- 02015107 Febrile[Widal.Weli-FElAgglutinins 400/-
600/- HBe Antigen Detection 550/-
600/- 02015108 (HBe Ag)
600/- 02015109 CMV)Antibody(Cytomegalo[IGM]Virus 350/-
1000/-600/- 02015110 Brucella Antibody 420/-
Breast Cancer ERPR and 2400/-
350/- 02015111 HER2/NEU
Anti HCV IIIrd Generation
350/- 02015112 Elisa 350/-
370/- Epstein Bar Virus IGM 600/-
370/- 02015113 [VCA Elisa]
02015114 HEV IgM Elisa 700/-
700/- Legionella Pneumophila-
600/- 02015115 Elisa 600/-
02015116 Elisa for Pregnancy 630/-
2000/- Elisa for Mumps (IgG
1350/- 02015117 Antibody) 450/-
300/- Elisa for Measles (IgG 450/-
300/- 02015118 Antibody)
Mumps Elisa (IgM
300/- 02015119 Antibody) 520/-
300/- 02015120 HIV P24 Antigen 600/-
02015121 Vivax Antigen 350/-
300/- Anti Smooth Muscle 500/-
300/- 02015122 Antibody (ASMA)
Anti-Mitochondrial 750/-
340/- 02015123 Antibody-M2 (AMA-M2)
Anti-Nuclear Antibody/ 450/-
02015124 ANF/ ANA
420/-600/- 02015125 ANA IFA (HEP-2) Method 960/-
Anti-Native
1000/- 02015126 DeoxyribonucleicDNA) Acid (Ds- 700/-
820/- 02015127 Antismith Antibody 650/-
840/- 02015128 Rubella IgG/IgM Antibody 360/-
1200/- 02015129 Rubella IgG & IgM 650/-
1000/- 02015130 RubeolaRubeola IgG/IgMAntibodiesAntibodyIgG & 1000/-
600/- 02015131 IgM 1400/-
600/- Leptospira Antibody 840/-
200/- 02015132 IGM/IGG
40
NAME OF
CODE INVESTIGATION
02015133 Leptospira AntibodyIGM IGG &
02015134 CryptococcusLatex DetectionAntigen-(CSF)
02015135 FalciparumADA (AdenosineAntigen
02015136 Deaminase- Body Fluid)
02015137 Anti MantouxHAV-TotalTest(IGG &
02015138 CytomegaloIGM)Virus (CMV
02015139 )Antibody [IGG]
02015140 CMV IgM + IgG
02015141 Chopra Aldehyde Test
02015142 AmnioticSpingomylFluid-Lecithin
02015143 AmoebiaisScreeningAntibodies [IHA]
Amoebic Serology
02015144 KOH Mount for Fungal
02015145 CampylobacterElements DetectionJejieni
02015146 Antigen Detection I
02015147 HIV Test (1 & 2)
02015148 Typhi DOT-M
02015149 (HBCHepatitistotal,B-Core,IGG + IGM)total
02015150 Anti HBC Antibody (IgM)
02015151 Anti HBC Antibody (Total)
02015152 Anti HBE
02015153 Hepatitis Be Antibody
02015154 Hepatitis D Virus Antibody
02015155 HLA-B27,HLA B27DiseaseCHN
Association, Flow
02015156 HLA-ABCCytometry& DR Tissue
02015157 Crossmatch
02015158 HCV RNA PCR Qualitative
02015159 HepatitisGenotype,C ViralLIPARNA
Varicella- Zoster Virus IGG
02015160 VarcillaTitresZoster IgM
02015161 Varcilla Zoster IgG & IgM
02015162
Annexure-I
Maximum Maximum
Approved Approved
1650/- 02015163 AntiMicrosomal-1)LKM-1 (LiverAntiboKidney 820/-
1300/- 02015164 Viable MTBPCRDetection- 1500/-
360/- 02015165 HIVPeriodQualitativeDetection)(Window 1200/-
450/- 02015166 Anti Sclero 70/ SCL 70 1300/-
150/- 02015167 Panel-Comprehensive(MolecularCNSDia 6800/-
720/- 02015168 HIV ProviralQualitativeDNA Detector 1100/-
320/- 02015169 HepatitisQuantitativeB PCR 1900/-
600/- Hepatitis B Virus PCR 3000/-
100/- 02015170 Qualitative
400/- 02015171 Anti GBM Antibody+ 900/-
280/- 02015172 HSV DNA PCR 1500/-
800/- 02015173 Anti RNP-Sm Antibody 1000/-
100/- 02015174 AntibodyProteinto RibonucleoIgG 1100/-
360/- 02015175 NBT Reduction Test 720/-
02015176 Anti Jo Antibody 520/-
450/- 02015177 Anti Jo-1 Antibodies 840/-
160/- 02015178 Antibody to SSA/SSB 2000/-
720/- 02015179 JapaneseAntibody Encepahilitsto SSB/LA 720/-
720/ 02015180 Virus PCR (JE Virus P 1500/-
720/ RT-PCRHIV-1 RNSwithQuantitativeCD-3, CD-4, 3800/-
550/- 02015181 CD
550/- 02015182 RNS Study/ Decrement 350/-
1450/- 02015183 HIV Viral Load CD4 & CD8 3200/-
920/- 02015184 AntiAntiEndomysialRNP- SmAntibodyIgG 1100/-
1500/- 02015185 IgA 720/-
2000/- 02015186 CD-4, CD-8 700/-
02015187 CD 10 1200/-
2500/- 02015188 CD 20 920/-
9500/- 02015189 CD 3 920/-
520/- 02015190 CD 30 920/-
720/- 02015191 HCV RNAViralQuantitative/Load 6000/-
1400/- 02015192 HBV Quantitative 5500/-
41
NAME OF
CODE INVESTIGATION
02015193 HBV DNA Qualitative
02015194 MycobacteriumIgA/IgG/IgM
02015195 MycobacteriumIgG/IgMSerology
02015196 TuberculosisTB PCRMycobacterium(MycobacteriumSerology EL
02015197 TreponematuberculosisPallidumPCR)
02015198 TreponemalAntibody DetectionPallisum,
02015199 AutoimmuneFTPA-ABFHepatitis
02015200 AntinuclearPanelantibody Panel
02015201 (14 antibody panel)
02015202 Anti CCP Antibody
02015203 Anti Centromere Antibody
02015204 Serum Procalcitonin
02015205 HSVSerum(1+2)PrealbuminIgG/IgM
02015206 Antibodies
02015207 HSV (1+2)(1+2)IgGIgMand HSV
02015208 Chikungunya Test
02015209 ANA/ ANF in Dilution
02015210 BronchialCulture &AspirationSensitivityfor
02015211 BronchialBronchialAFBAspirationAspirationCulture forfor
02015212 BronchialFungalAspirationStain for
02015213 BronchialGramAspirationStain for
02015214 CVP TipTBPCRfor Culture &
02015215 DialysisSensitivityCatheter Tip for
02015216 Ear/ Eye/ Nasal/C/S Tongue
02015217 SwabSensitivityfor Culture &
02015218 ProstrateProstaticMicroscopySpecificSecretionAntigenfor
02015219 (PSA)
Annexure-I
Maximum Maximum
Approved Approved
1900/- 016 Obstetric Cases
600/- 02016001 Examinationanaesthesiaunder 2430/-
500/- 02016002 Lap.LaparoscopyDye Test with(Gynae)removal 6060/-
1900/- 02016003017 processingBiopsiesof adhesionsper(Specimentissue type) 8000/-
850/-300/- 02017001 Biopsy [Large] 600/-
2000/- 02017002 Biopsy [Medium] 500/-
900/- 02017003 Biopsy [Small] 350/-
1100/- 02017004 Biopsy [Extra Large] 800/-
018 Head & Neck Cancer
450/-
800/- 019 Cardio Respiratory
2000/- Procedures
550/- 02019001 Direct Laryngoscopy 4380/-
280/- 02019002 Bronchoscopy 2400/-
550/- 02019003 Mediastinoscopy 2880/-
500/- 02019004 Pleural Biopsy 3630/-
1000/- 02019005 Thoracoscopy 6600/-
300/- 02019006 PulmonaryBMRfunction test 700/-
500/- 02019007 SpirometrySpirometrywith Helium 700/-
100/- 02019008 SpirometryDilutionwith Helium 1620/-
100/- 02019009 Dilutioncapacitywithstudiesdiffusion 1620/-
1400/-300/- 02019010 Pulmonery exercise testing 940/-
300/- 02019011 Punctal Cautery 100/-
02019012 NT Pro BNP 1000/-
300/- 02019013 Cardioversion 1400/-
150/- 02019014 Cardiac Troponin I 400/-
500/-
42
NAME OF
CODE INVESTIGATION
02019015 TEE with Anesthesia
02019016 Testicular
02019017 FlexibleFlexibleDiagnostic-Bronchoscopy-Bronchoscopy-TBNA
02019018 FlexibleTherapeuticBronchoscopy-
02019019 Glue
Flexible Bronchoscopy-
02019020 Baloon Tampete
Flexible Bronchoscopy-
02019021 Toileting
Rigid Bronchoscopy-
02019022 Diagnostic
Rigid Bronchoscopy-
02019023 Massive Haemoplysis
02019024 Fibroptic bronchoscopy
Fibroptic Bronchoscopy
02019025 Cardiacwith Washing/Biopsy/ Cardio Thoracic
020
Procedures
02020001 Test of Pacemaker
Stress Myocardial Study
02020002 (MBI/ TR)
02020003 Echo Screening
02020004 Stress Echo/EchoDobutamine
02020005 Foetal Echocardiography
02020006 2CardioD EchoTocographywith colour
02020007 Doppler/Cardiography2D Echo
02020008 TransHolterOesophaedralAnalysis(TEE) & HolterEcho
Report (with Prd.
02020009 Specification)
Cardiac Cath Angiography
02020010 (Without Coronary
Annexure-I
Maximum Maximum
Approved Approved
2500/- Angioplasty)
800/- 02020011 Aortogram 3900/-
10000/-2500/- 02020012 PackageCardiovascularinvestigationcharges for 410/-
4000/- 02020013 Stress Thallium 3600/-
4000/- 02020014 Muga (Resting) 1440/-
2600/- 02020015 EchoMugaColour(Stress)Doppler 1800/-
5000/- 02020016 1440/-
6200/- 02020017 CheckAbdomen/Angio 7000/-

021 Gastroentrology
2100/- 02021001 Gastroscopy 1170/-
Gastric & Duodenal Biopsy 1560/-
2500/- 02021002 (Endoscopic)
580/- 02021003 ERCP 4000/-
7200/-
720/- 02021004 ERCP Fluroscopy 2200/-
1950/- Upper G.I. Endoscopy 1100/-
1320/- 02021005
360/- 02021006 Upper G.I.BiopsyEndoscopy with 1300/-
1320/- 02021007 Sigmoidoscopy (rigid) 1400/-
840/- 02021008 Sigmoidoscopy (flexible) 1200/-
1470/- Oesophagoscopy 1100/-

02021009
13200/-
43
NAME OF
CODE INVESTIGATION
02021010 Colonoscopy
Colonoscopy-FullPKG) (GAS-
02021011
24 H PH Metry
02021012
24 H PH Metry (BS)
02021013
Nephrology /
022
Genitourinary
02022001 Biopsy(Cystoscopic)of Bladder
02022002 Urethroscopy
02022003 Glomerular Filtration Rate
Urethral dialatation-
02022004 Diagnostics
02022005 VisuallyUroflowEvokedStudyPotential
02022006 (Micturometry)
Urodynamic Study
02022007 Cystoscopy(Cystometry)with
Retrograde Catheter
02022008 CystoscopyUnilateralwith
Retrograde Catheter
02022009 Bilateral
02022010 Cystoscopy Diagnostic
02022011 Cortisol-blood
02022012 Voiding-cysto-urethrogram
02022013 RenalEvaluationTransplant
Orthopaedic Surgery
023
ArthrographyProcedure &
02023001 Osteomedullography
02023002 Arthroscopy - Diagnostic
024 Neurology
02024001 PlacementLumberofPressureICP Monitor -
02024002 Monitoring
Annexure-I
Maximum Maximum
Approved Approved
02024003 Nerve Biopsy 8500/-
1800/- 02024004 Brain Biopsy 8500/-
02024005 Brain Mapping 3000/-
2000/- 02024006 Ambulatory Electro Ence 5000/-
02024007 Blink Reflex 500/-
02024008 Decrement Test 650/-
4000/- 02024009 EMG Four Limbs 900/-
02024010 EMG Two Limbs 480/-
5500/- 02024011 NCV Four Limbs 900/-
02024012 NCV Two Limbs 500/-
02024013 EMG-Facial 500/-
02024014 NCV-Facial 500/-

8000/- 02024015 NCV+EMG-Facial 950/-
550/-
6000/- 02024016 Spincter-EMG
500/- 02024017 H Reflex 500/-
550/-
1000/- 02024018 SSEP (Lower Limbs)
02024019 SSEP (Upper Limbs) 550/-
500/- 02024020 SSEP-UL/LL 1000/-
600/- 02024021 VEP (Flash) 550/-
550/-
02024022 VEP (PR)
1200/- 02024023 Counsl of INH Patient 200/-
02024024 Spl Edu Assessment 250/-
4000/- 02024025 Baer Study 550/-
02024026 Baer/ Threshold 1000/-
6000/- 02024027 Councelling & Therapy 200/-
5000/- 02024028 IQ Assessment 300/-
240/- 02024029 Neuro Psychological T 850/-
360/- 02024030 Personality & IQ Child 450/-
1500/- 02024031 Personality Development T 650/-
02024032 SSR 700/-
Lumbar puncture with CSF
11000/- 02024033 Monitoring 1500/-
02024034 HER-2/ NEU 1200/-
11000/- 025 Breast
02025001 Mammography (Single
6000/- 02025002 Mammographyside) (Both 800/-
6100/- sides) 1500/-
44
NAME OF
CODE INVESTIGATION
026 Gynae,ChargesOperation
02026001 Diagnostic Curettage
02026002 Fractional Curettage
02026003 LaproscopicHysteroscopyOperationsDiagnostic
027 GastrohepaticIn Gen. Surgery/ Nephro-/
02027001 Diagnostic Laproscopy
028 SpecialisedInvestigations/ProceduresC.T. Scan/
02028001 C.T.Cat ScanHead (C.T.)Scan Involv.Head
02028002 Spl. Investigation
02028003 C.T. Scan Brain

02028004 HRCT Chest Thorax
02028005 C.T. Chest (HRCT)
02028006 C.T. Scan Chest

C.T. Spine
(Cervical,Dorsal,
02028007 Lumbar,Sacral)
CT Angiogram of Cervical
02028008 and Intra
02028009 ReconstructionC.T. Cervical C.T.only3D--
02028010 C.T. Guided Biopsy
02028011 C.T. Guidedcath drainagepercutaneous
C.T. Myelogram
02028012 (Cervical Spine)
02028013 (LumbarC.T. MyelogramSpine or D/S)
02028014 CT Pelvis with Hip Joints
02028015 CT KUB (Plain)
02028016 CT Sacro Iliac Joint
02028017 CT Pituitary/ Sella
02028018 CT Cisternography
02028019 CT Petrous Temporal Bone
Annexure-I
Maximum Maximum
Approved Approved
02028020 CT Sacrum & Coccyx 3500/-
02028021 C.T. Scan Upper Abdomen 3000/-
3000/-
02028022 C.T. Scan Lower Abdomen 3000/-
3400/-
02028023 C.T. Scan Whole Abdomen 5000/-
7500/- C.T. Shoulder Joint/ Knee
02028024 Joint/OtherElbowJointJoint/(Plain)Any 3500/-
7000/- 02028025 CT Base of Neck 2000/-
02028026 C.T. ScanSoft NeckTissue)(Thyroid 3000/-
1600/- 02028027 CT Ankle with Foot 2000/-
2300/- 02028028 C.T. Scan Orbits/Eye 3000/-
CT Arm/ Humerus/
1600/- Leg/Forearm/Tibia-Fibula/Radius-Ulna/Thigh/
6000/- 02028029 Femur (Single) Plain 4500/-
02028030 C.T. Scan Limbs 2500/-
4000/-
02028031 CT Both Thigh 2000/-
3500/-
02028032 C.T. Scan Whole Body 10000/-
02028033 CT Extremities 2000/-
3500/- C.T. Scan of Para Nasal
02028034 Sinus 3000/-
7200/-
1200/- 02028035 CT AngiographyCT guided FNACof Brain/ 2500/-
2000/- 02028036 Carotid/ Thorax/ Neck 5400/-
2500/- 02028037 CTAngiography64 Coronary 10000/-
CT Angiography of Brain/
3500/- Carotid/ Thorax/ Neck/
3500/- area/Abdomen/RenalPulmonaryarea/Extremities/Peripheralarea with
3000/- 02028038 Visipaque 6500/-
3500/- 02028039 CTCTRenalAngioAngiographyBoth Lower 5000/-
2500/- 02028040 Limbs 10000/-
2500/- CT Angiography of Neck
1600/- 02028041 CT AngiographyVessels of 5000/-
3000/- Abdomen/ Extremities/
02028042 Renal area/ Peripheral 6000/-
45
NAME OF
CODE INVESTIGATION
area/ Pulmonary area
PET CT Scan
(Whole Body)
02028043 (includingGlucose)Flurodeoxy
02028044 Therapeutic Aspiration- CT
02028045 Diagnostic Aspiration- CT
02028046 Ionic Contrast (20 C.C.)

02028047 IonicNon-ionicContrastContrast(50 C.C.)(10
02028048 C.C.)
02028049 Non-ionicC.C.)Contrast (25
Non-ionic Contrast (50
02028050 Non-ionicC.C.)Contrast (100
02028051 C.C.)
02028052 3D Reconstruction charge

029 MRI Brain/MRIBrain with
02029001 Protocol/InternalCSFEarStudy/
02029002 MRI Base of Skull

02029003 MRI Orbits
02029004 MRI Face
MRI Nasopharynx and
02029005 PNS
02029006 MRI Pharynx

02029007 MRI Neck
02029008 MRIMRIThyroid/PituitaryCranio-
02029009 Vertebral (C.V.) Junction/
MRI Temporal Bones
02029010 MRI(Unilateral)Venography/
02029011 Angiography
MRI Arm/ Fore Arm/ Thigh/
02029012 Femur/ Leg/ Foot
02029013 MRI Arm (Humerus) (Left/
Annexure-I
Maximum Maximum
Approved Approved
02029014 MRI- Single Joint 5400/-

02029015 MRI- Both Joints 9000/-
20000/- 02029016 MRIMRISacroSpineIliac(Cervical/Joints 5400/-
Dorsal/ Lumbar/ Cervico-
3000/- Dorsal/ Dorso-Lumbar/
02029017 Lumbo-Sacral) 5400/-
1600/- MRI Lumbar Spine &
02029018 Sacroiliac Joint 6000/-
270/- 02029019 Double Region& Spine)Plain (Brain 9000/-
675/- 02029020 Tripple Region& Spine)Plain (Brain 13000/-
500/- 02029021 MRI CSF Flow Study 1500/-
750/- 02029022 MRIMRIDiffusionSpectroscopyTensor 1500/-
02029023 MRI SWIImaging(Susceptibility(DTI) 1500/-
1250/- 02029024 Weighted Image) 1500/-
2100/- 02029025 MRI Hip 6000/-
02029026 MRI Urogram 5400/-
1200/- 02029027 MRI Pelvis 6000/-
02029028 MRCP 5000/-
6000/- 02029029 MRI UpperMRI ExtremitiesAbdomen with 6000/-
02029030 MRCP 6000/-
5400/- MRI Temporomandibular
6000/- 02029031 Single Joint 5000/-
5400/- MRI Temporomandibular
02029032 Double Joints 6000/-
6000/-
02029033 MRI Upper Abdomen 5400/-
5400/- MRI Upper Thigh & Lower
6000/- 02029034 Abdomen 7000/-
5400/- 02029035 MRIMRI LowerWholeAbdomen/Abdomen 9000/-
5000/- 02029036 Pelvis 5400/-
6000/- 02029037 MRI Breast 6000/-
02029038 MRI Thoracic Outlet 5400/-
5400/- 02029039 MRI Spine Screening 5400/-
02029040 MRI Brachial Plexus 5400/-
5400/- 02029041 MRI Chest 5400/-
5400/-
46
NAME OF
CODE INVESTIGATION
02029042 MRISpectroscopyBrain with
02029043 MRI Brain with Perfusion
MRI Brain with Orbit/ PNS/
02029044 Angio/ Neck Angio
(DiffusionMRI BrainTensorwithImaging)/DTI
WeightedSWI (SusceptibilityImage)/ Cranial
02029045 MRINervePerfusionEvaluationStudy
02029046
02029047 MRI Screening
Screening Single Area with
02029048 Films
Screening Double Area
02029049 with Films
02029050 MRI Small Part
02029051 MRI Other Region
02029052 Contrast (Ionic/ Non-ionic)
030 Other Investigations
02030001 Fluoroscopic Screening
02030002 BoneOxygenDensitometrySaturationSingle
02030003 site
Bone Densitometry Two
02030004 Bone Densitometrysites Three
sites ( Spine , Hip & one
02030005 Bone Densitometryextremity) Whole
02030006 body
02030007 A.V. Fistula
031 Immunology
02031001 Hepatitis B DNA

HBV DNA Quantitative/
02031002 NuclearViralMedicinesLoad
032
02032001 Gallium-67Isotope VenographyScan/Ghallium
02032002 Scan
02032003 Iodine-131ThyroidThyroidScan Scan
02032004 Thyroid (Tc99m) Scan
02032005 Para Thyroid Scan
02032006
Annexure-I
Maximum Maximum
Approved Approved
6000/- 02032007 Spect MyocardialThallium ScanPerfusion 9000/-
7300/- 02032008 Scan (Thalium/ Tetro) 11000/-
Spect Myo Perfusion Rest
6500/- 02032009 Scan (Thalium/ Tero/ Mie 5500/-
02032010 NuclearRadio-IsotopeBlood PoolUretericScan 2000/-
02032011 WholeRefluxBody(Indirect)Tc-V-DMSA 3000/-
6000/- 02032012 Scan 3500/-
3500/- Brain Spect (Tumour
5400/- 02032013 TumourImaging)Immagery 2500/-
02032014 5000/-
1500/- Bone Scan Spect (Single
02032015 Region) 1800/-
3000/- Bone Scan- three phase
4000/- 02032016 Bone(SingleScan SpectRegion)(whole 2700/-
5400/- 02032017 body) 3000/-
2500/- 02032018 Tc 99m DMSA Renal Scan 2000/-
033 Profiles
120/- 02033001 Lipid Profile 700/-
120/- 02033002 TotalThyroidDiabeticProfileProfile 1200/-
800/- 02033003 Pre Cath Profile 1000/-
02033004 850/-
1200/- 02033005 Coagulation Profile 550/-
02033006 LFT [Liver Function Test] 750/-
1600/- 02033007 PreDialysisDialysisProfileSerology 600/-
2200/- 02033008 Hepatitis B Profile 500/-
3000/- 02033009 Hepatitis Panel 3000/-
02033010 1800/-
Neuro Profile
5200/- 02033011 Septic Profile 2000/-
02033012 900/-
6000/- 02033013 Paediatric Septic Profile 1800/-
Basic Metabolic Panel
3500/- 02033014 Comprehensive(BMP)Metabolic 320/-
8500/- 02033015 AnaemiaPanelScreen(CMP)(HAEM1) 500/-
1800/- 02033016 Thrombocytopenia Screen 2800/-
2500/- 02033017 (HAEM2) 3400/-
1800/- 02033018 Mycloma Screen (HAEM3) 2700/-
6000/- 02033019 Lymphoma Screen 2000/-
47
NAME OF
CODE INVESTIGATION
(HAEM4)
02033020 Polycythaemia (HAEM5)
Thallasaemia Patient
02033021 Screen (HAEM6)
Thallasaemia Counselling
02033022 Serum (HAEM7)
02033023 CRBSI
02033024 ACTH Stim
02033025 Growth Hormone Stim
02033026 Male GnRH Stim
02033027 Female GnRH Stim
02033028 Bone Marrow Profile
02033029 EP Screening Profile
02033030 Torch Profile
02033031 Renal Profile
Annexure-I
Maximum
Approved
Rate (INR)
(Rupees)
1800/-
3000/-
1200/-
550/-
1900/-
2000/-
3500/-
3300/-
550/-
1100/-
1500/-
330/-
48
RATES FOR IMPLANTS

03- IMPLANTS
CODE
001
03001001
03001002
03001003
03001004
03001005
03001006
03001007
03001008
03001009
03001010
03001011
03001012
03001013
03001014
03001015
03001016
03001017
03001018
002
03002001
03002002
Annexure-I
NAME OF THE ITEM

Cardiology Implantation Devices
Pacemaker (Single Chamber)- Ordinary (SSI Autocapture)
Pacemaker (Single Chamber)- With rate modulation (SSIR)
Pacemaker (Dual Chamber) (DDD/DDDR/VDDR)
CRT (Cardiac Resynchronization Therapy)
AICD (Automatic Implantable Cardioverter Defibrillater)
CRT + AICD combination
BMS (Bare Metal Stent)(made of Steel)
BMS (Bare Metal Stent)(made of alloy e.g. Cobalt, Chromium,
etc.)
DES (Drug Eluting Stent)- Sirolimus-eluting e.g. Cypher, etc.
DES (Drug Eluting Stent)- Higher Sirolimus derivatives e.g.
Endeavour, Promus, Xcience, etc.
DES (Drug Eluting Stent)- Paclitaxel-eluting e.g. Taxus, etc.
PDA- closure device
ASD/ VSD- closure device
Mitral Baloon, e.g. Inoue Baloon
Pulmonary Valvoplasty Baloon
Mitral/ Aortic Heart Valve
TTK Chitra (Mitral/ Aortic Heart Valve)
Heart Valves- Annuloplasty Ring
Opthalmology
Hydrophobic Foldable IOL
Silicon Foldable IOL
Maximum Approved Rate (INR)
(Rupees)
45,000/-whicheveror the actualis less cost,

68,000/-cost, whichever+ VAT or theis lessactual
1,20,000/-cost, whichever+ VAT oristhelessactual
2,50,000/-whicheveror theisactualless cost,
40,000/- + VAT or the actual
cost, whichever is less
1,05,000/- + VAT or the actual
cost, whichever is less
50,000/-whichever+ VAT or theis lessactual cost,
50,000 whichever+ VAT or theis lessactual cost,
30,000 whichever+ VAT or theis lessactual cost,
5,000/-
4,000 /-
49
CODE
03002003
03002004
003
03003001
03003002
03003003
004
03004001
03004002
03004003
03004004
03004005
005
03005001
03005002
03005003
03005004
03005005
03005006
03005007
03005008
03005009
03005010
03005011
03005012
03005013
03005014
03005015
03005016
03005017
NAME OF THE ITEM
Hydrophilic Acrylic Lens
PMMA IOL
ENT
One-sided Hearingin theAidcanal(Bodytypeworn/Pocket/Behind(conventional) the ear type or
Bilateral Hearing Aid
Digital HearingWestAidBengal(to beHealthpurchasedSchemewith Authority)the permission of the
Neuro Implants
Type of Neuro-implant
DBS Implants
Intra-thecal Pumps
Spinal Cord Stimulators
CPAP Machine
BIPAP Machine
Orthopaedic implants
Depuy (TKR) Knee
Zimmer (USA) Knee
Cemented Bipolar Hip (Zimmer)
Uncemented Total Hip (Zimmer)
Cemented Bipolar Hip (Depuy)
Uncemented Total Hip (Depuy)
Cemented Total Hip (Depuy)
DHS Plate Screw
Proximal Femur Nail
Locking Plate & Screw- for Humerous
Locking Plate & Screw- for Distal Tibia
Locking Plate & Screw- for Proximal Tibia
Locking Plate & Screw- for Proximal Femur
Locking Plate & Screw- for Shaft Femur
Locking Plate & Screw- for Radius Ulna
Locking Plate & Screw- forJointDistal Humerous & Elbow
Locking Plate & Screw- for Shaft Humerous
Annexure-I

(Rupees)
6,000 /-
500/-
10,000/-
20,000/-
30,000/-
Prescribing Authority CeilingRate BatteryLife of

Neurologisthospitalof a recognised 3,60,000/- years3-5
Any two specialists of 2,62,000/- 7 years
concerned speciality/ HoD
AnaesthesiologyNeurosurgery/of Neurology/ of 2,62,000/- years3-5
recognized hospital
50,000/-
1,00,000/-
Maximum Ceiling Rates (Rupees)
75,000/-
74,880/-
41,080/-
69,992/-
38,500/-
77,000/-
46,500/-
3,500/-
5,720/-
5,500/-
6,500/-
5,500/-
6,500/-
9,000/-
2,500/-
4,500/-
5,500/-
BatteryCost of
2,50,000/-
2,25,000/-
2,00,000/-
50
CODE
03005018
03005019
03005020
03005021
03005022
03005023
03005024
03005025
03005026
03005027
03005028
03005029
03005030
03005031
03005032
03005033
Annexure-I

NAME OF THE ITEM (Rupees)
Locking Plate & Screw- for Buttress Plate & Screw 5,500/-
ISO-Elastic Nail (Per Piece) 2,500/-
Interlocking Nail for Tibia & Femur 3,500/-
PFN Nail for Proximal Femur 8,000/-
DHS Plate Screw for Trochanteric Fracture 3,500/-
Humerous Plate 3,500/-
Humerous locking Plate & Screw 5,500/-
Humerous locking T- Buttress Plates & Screw 4,500/-
Elbow Joint- fixation by locking Plate & Screw 3,500/-
Replacement of Elbow Joint 20,000/-
Radius Ulna- Locking Plates & Screw 4,500/-
Wrist joint with locking Plate & Screw 2,500/-
Soldier Joint- With Jess Fixator 6,500/-
External & ILLIZAROV- Femur 7,000/-
External & ILLIZAROV- Tibia 7,000/-
External & ILLIZAROV- Pelvis 7,000/-
51

Revised Rate List

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Revised Rate List

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Annexure-I

01003003 Swallowing Therapy 250/-

(Notification No. 796-F (MED) dated 31-01-2011)

(Notification No. 796-F (MED) dated 31-01-2011)

01004051 Iris cyst removal 1000/-

01004073 Endo Laser 2400/- 01004094

01004075 C 3F 8 Gas 2400/- 01004096

0100407601procedurePhPFCLeye 15000/-2400/- 01005001005

01004091 Anterior Vitrectomy 5000/- 01007006

01007019 Traction + IFT 150/-

01007020 Traction + Stimulation 100/-

01007022 Traction + SWD + IFT 200/-

01007023 Traction + US 140/-

01007024 Traction + US + IFT 200/-

01007027 IFT + PWB 150/-

01007028 PWBExercise-+ KneeperJointsittingSpad 60/-

01007030 SWD + IFT 100/-

01007031 US + IFT 100/-

01007032 US + IFT + Stimulation 200/-

01007035 US + SW + Traction 200/-

01007036 US + Tens 100/-

01007037 US + Stimulation 100/-

01007038 Knee Joints Spad Fraction 100/-

01007040 Interferential Therapy 100/-

01008029 Apicoectomy Molar Tooth 2250/-

Extraction of MISP Tooth

01008047 Glass Ionomer Filling 400/-

01008051 Jacket Crown Acrylic 1500/-

01008058 Pulpotomy 750/-

01012033 Laparotomy 20000/-

01012034 Abdominal Hysterectomy 22000/-

01012036 Myomectomy 22000/-

01012037 Vaginoplasty 22000/-

01012039 RVF Repair 25000/-

01012040 Other Major Operations 25000/-

01012041 Manchester Operations 20000/-

01012049 Polypectomy 3600/-

01012050 Other-Minor Operation 3600/-

01012052 Excision Vaginal Septum 5900/-

01012053 Laparoscopy Diagnostic 6000/-

01012060 Hysteroscopy TCRE 11500/-

01012063 Hysteroscopy Diagnostic 7300/-

01016019 Dilatation (Stricture) (BS) 4200/- 01016042

Gastrostomy (PEG) 7000/-

Gastrostomy (PEG) (BS) 11000/-

Glue Injection 4500/-

Glue Injection (BS) 7000/-

Hemosta by Glod Probe 7000/-

Hemostatic Clip 7000/-

01016051 Pre Cutting 4500/-

01016056 Sclerotherapy (BS) 3800/-

01017034 Parotidectomy - Radical 22000/-

01017035 Parotidectomy - Total 15000/-

01017036 Repair of Parotid Duct 20400/-

01017038 Hemithyroidectomy 15000/-

01017049 Laryngo Pharyngectomy 43500/-

01018008 Total Thyroidectomy 30000/-

01020020 Multiple Lobectomy 37000/-

0102002601SurgeryThoracotomyforLungDestroyedfor BPF 37000/-37000/-

01020030 Tracheal Stenosis Surgery 37000/-

01023093 Fistula/ Fistulotomy 12000/-

01023094 Hernioctomy 21000/-

01024105 Urethroplasty 1st Stage 14000/- 01024128

0102502501CleftCleftSeverePalateLip Degree- repair.Repair 33800/-32400/-